![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 16 to 40 of 40. Go back in thread:
Posted by Pfinstegg on May 29, 2003, at 20:22:44
In reply to Re: HPA, Atypicals and Opiates?--Cam?? » SLS, posted by Shawn. T. on May 29, 2003, at 19:39:25
Just to add my two cents worth, I'm mixed melancholic-atypical, but more atypical. I was a non-suppressor with a low-normal 24-hour cortisol; after TMS, I became a suppressor, and am trying hard to stay that way-for me, this coincided with a remission. (I'm female).
Pfinstegg
Posted by MB on May 29, 2003, at 20:29:55
In reply to Re: HPA, Atypicals and Opiates?, posted by davpet on May 28, 2003, at 12:47:45
Hmmm, yeah, that makes sense. Is that why they down-taper your doses after a Prednisone cycle? The whole negative feedback mechanism inherent in the HPA axis seems like it would make modulating this system difficult! Also, I guess another question is: which is primary, the physiochemical dysfunction of the brain, or the dysfunction of the HPA. It's like the "chicken and egg" riddle. Maybe we can't separate the endocrine system from the nervous system as strictly as it would seem. Glands have receptors for monoamines, and the brain has receptors for hormones, and the whole thing is so confusing *I* sure as heck can't figure it out...
MB
> MB i think Prednisone augmentation would only be useful in the short term , in the long term it would then cause further down-regulation of the Glucocorticoid-Receptors (GR) and make matters worse
>
> (I've seen this when my dog had cancer they gave her Prednisone her swelling virtually disappeared and then rebounded much worse 10 days later)
>
>
Posted by MB on May 29, 2003, at 20:35:52
In reply to Re: HPA, Atypicals and Opiates?--Cam??, posted by cybercafe on May 28, 2003, at 14:54:05
> actually i think most people who take parnate will eat less and definately sleep less
Really? That's good news. My misconception might have come from so many reports of people gaining weight on MAOIs (including Parnate) I just figured they must slow you down and increase appetite.Anyway, you said SSRIs give you *more* energy? You're lucky. They drain me. At first I feel agitated and fatigued at the same time, and then, after a few months, I just feel fatigued. Unfortunately, increasing the dose brings back the agitation and worsens the fatigue. Uggg
MB
ps. I'm glad they work for you, though.
Posted by MB on May 29, 2003, at 21:08:46
In reply to Re: HPA, Atypicals and Opiates?--Cam?? » MB, posted by jrbecker on May 29, 2003, at 16:13:19
<cut>
> Some experts believe that a potentiator of CRH might be beneficial for atypical depressives, while others disagree.
I think I read somewhere that naltrexone might help in this area...stimulating the hypothalamus to release CRF...
<cut>
> I remain sleepy throughout the day and have a lot more rebound energy at night. I've even found that if I push my sleep cycle further into the night and wake up later in the day, that I have a much a more normal circadian clock.I've noticed the same thing. After a night's sleep, I still feel groggy (I also suffer from Restless Leg Syndrome) and my morning .5mg Klonopin dose knocks me on my butt. However, I start to feel rejuvinated as the sun goes down, and I hardly feel my evening 1mg dose of Klonopin at all. Also I've been noticing that my moods cycle in a way opposed to what you would see in someone with Seasonal Affective Disorder: I'm more sluggish, tired, and depressed in the Summer than in the Winter. In the Spring and Summer, I actually *loathe* to go out in the sun, and usually wait until dusk to go outside, to do my shopping, etc. (or if I get up before dawn, and rev up on coffee--which activates the stress system--I can function somewhat normally).
<cut> (re: Gepirone)
> This is probably due not only due to its 5HT1A action but also because one of its metabolites is an alpha-2 adrenergic antagonist (which increases NE and dopamine).
Would this make it like a BuSpar/Remeron hybrid in terms of action?
<cut>> On another note, have you experimented with supplements -- SAMe, Folate, Fish oil, DHEA, NADH. What about light therapy (it's actually helped my energy levels). And what about CBT? Given it any thought? There's lots of proof that atypical depression responds to it.
I've experimented very little with the above supplements. SAMe made me restless and irritible (much in the way SSRIs do, hence the Klonopin ingredient in my cocktail). I'd really like to try CBT.
Thanks for the hopeful/informative input and the links...
MB
Posted by cybercafe on May 30, 2003, at 16:36:35
In reply to Re: HPA, Atypicals and Opiates?--Cam?? » cybercafe, posted by MB on May 29, 2003, at 20:35:52
> > actually i think most people who take parnate will eat less and definately sleep less
>
>
> Really? That's good news. My misconception might have come from so many reports of people gaining weight on MAOIs (including Parnate) I just figured they must slow you down and increase appetite.i know there are some people who gain weight on parnate or even fatigue but it is much much more likely that a person will lose weight and sleep much less... i'm sure you've read the many many posts about people wondering what med to take to help with parnate insomnia (which i loved btw as someone who used to sleep 10, 12, 14 hours a day)
parnate i found very stimulating.... great.... libido really goes up to
> Anyway, you said SSRIs give you *more* energy? You're lucky. They drain me. At first I feel agitated and fatigued at the same time, and then, after a few months, I just feel fatigued. Unfortunately, increasing the dose brings back the agitation and worsens the fatigue. Uggg
well it's actually more like... when i'm feeling okay i have thoughts come into my head "hey doing ___ would be fun" "hey this is fun" ... "i should do ___ today" ... without an AD i do not have any happy thoughts... so i wake up in the morning, no thoughts come into my head as per things i should do, so i just go back to sleep....
maybe i'm fatigued and don't notice it because there are all these things that seem interesting/fun that i want to do and am too busy doing ... when i was depressed *everything* bored me so i didn't actually do anything
anyways.... yeah i would definately recommend MAOIs... they're great drugs
Posted by Jota on May 30, 2003, at 21:14:54
In reply to Re: HPA, Atypicals and Opiates?--Cam??, posted by cybercafe on May 30, 2003, at 16:36:35
Might there be any link between high cortisol levels and the low testosterone levels found in a substantial subset of depressed men? (Pope et. al., American Journal of Psychiatry, Jan. 2003)
Posted by davpet on May 30, 2003, at 23:12:17
In reply to Re: HPA, Atypicals and Opiates?--Cam??, posted by Jota on May 30, 2003, at 21:14:54
You say you crave carbohydrates and that coffee brings temporary relief to your symptoms - these are classic signs of Reactive Hypoglycemia , have you ruled that out as a possibility
Posted by cybercafe on May 30, 2003, at 23:16:39
In reply to Re: HPA, Atypicals and Opiates?--Cam??, posted by Jota on May 30, 2003, at 21:14:54
> Might there be any link between high cortisol levels and the low testosterone levels found in a substantial subset of depressed men? (Pope et. al., American Journal of Psychiatry, Jan. 2003)
interesting.... i had low normal cortisol and high normal testosterone (atypical depression)
Posted by MB on May 31, 2003, at 19:13:48
In reply to Re: HPA, Atypicals and Opiates?--Cam??, posted by cybercafe on May 30, 2003, at 16:36:35
> i know there are some people who gain weight on parnate or even fatigue but it is much much more likely that a person will lose weight and sleep much less... i'm sure you've read the many many posts about people wondering what med to take to help with parnate insomnia (which i loved btw as someone who used to sleep 10, 12, 14 hours a day)
I *have* read the reports about Parnate and insomnia, but after years on the med-go-round, I have become very careful to not equate "insomnia" or "activation" with "energizing." For example, Effexor gave me horrible insomnia, and it was extremely activating (in that I had to keep wiggling my legs, etc.) but I was not energized; I was fatigued. Wired and tired, like a strung out coke-head. I hated it. I'd rather be fatigued and able to sleep, than fatigued and agitated...anyway, that's my explanation for having misgivings about Parnate despite the insomnia reports.
> parnate i found very stimulating.... great.... libido really goes up toThat's great that you found it both stimulating and non-fatiguing. The only med I've found like that was Adderall. It gave me insomnia, but I didn't care, because there wasn't fatigue mixed with the insomnia. Maybe Parnate would be like this.
> well it's actually more like... when i'm feeling okay i have thoughts come into my head "hey doing ___ would be fun" "hey this is fun" ... "i should do ___ today" ... without an AD i do not have any happy thoughts... so i wake up in the morning, no thoughts come into my head as per things i should do, so i just go back to sleep....
>
> maybe i'm fatigued and don't notice it because there are all these things that seem interesting/fun that i want to do and am too busy doing ... when i was depressed *everything* bored me so i didn't actually do anything
Well, I think you might be onto something regarding not noticing the fatigue due to busyness. When I'm up and moving, the fatigue is definitely less. It's just hard to get up and moving. This Lexapro/Klonopin combo I'm on is very unmotivating. If I have an appointment where I'm *committed* to get off of my lazy butt, then the fatigue isn't so bad (but moving around *does* give me tachycardia and head-rushes). I guess its all about compromises (e.g. "Would I rather think of killing myself 24/7 or would I rather be numb, anhedonic, and amotivated?"). Recreational drugs are nice, but they quit working very quickly and then there are two problems: a mood disorder + a chemical dependency. Woa, I'm getting off topic, ramble, ramble, ramble...> anyways.... yeah i would definately recommend MAOIs... they're great drugs
My GP "doesn't prescribe" Parnate, and my pharmacy doesn't carry it. I've alienated myself from all the pdocs in my town because I'm a non-compliant know-it-all, so getting help from a psych professional isn't an option. I might have to go out of state.
MB
Posted by MB on May 31, 2003, at 19:24:10
In reply to MB is this possible, posted by davpet on May 30, 2003, at 23:12:17
> You say you crave carbohydrates and that coffee brings temporary relief to your symptoms - these are classic signs of Reactive Hypoglycemia , have you ruled that out as a possibility
This is very much a possibility. I had a glucose tolorance test done, and they told me I was normal. However, it was the short test, not the long one (they checked me a few times over the period of an hour). I almost passed out in the parking lot on the way home, so I don't think they waited long enough to witness and measure the crash. The next time I had fasting blood work done (this time without drinking that sugar drink) my blood glucose level was 51 mg/dL, which the doc seemed concerned about. I know I have hypoglycemia, because sometimes I get shaky and weak and sweaty, and eating someting sweet corrects it immediately. However, the fatigue I described in the above post is subjectively different (it is annoying, but no where near as uncomfortable as a hypoglycemic attack). Also, after a hypoglycemic attack, eating sugar or carbohydrates will make me feel better immediately. While the fatigue I mentioned in the previous post is often exacerbated by munchi9ng out on carbs. I *do* think I have problems with low blood sugar, but I think there is something else going on as well. Two different types of fatigue...one gets better with eating, the other doesn't.
MB
Posted by davpet on June 1, 2003, at 4:14:15
In reply to Re: MB is this possible » davpet, posted by MB on May 31, 2003, at 19:24:10
The term hypoglycemia , doesn't just mean your blood sugar runs low sometimes , it means there is a problem with the hormones that regulate blood sugar (after the ingestion of high glycemic meal) . You said you have a hypoactive HPA axis thats another classic sign . You were right the correct glucose tolerance test is for four hours taken every half hour , to catch the peak and trough . Eating sugar to alleviate a hypoglycemic attack is only a quick fix as your body will then produce more insulin in response to the sugar lowering your blood sugar once more . The fatigue you talk about can definitely be attributed to hypoglycemia as your body is not able to efficiently metabolise its chief energy source , namely carbohydrates . The first rule of hypoglycemia is absolutely no sugar (or caffeine) of any kind . It takes at least six weeks of following a strict diet of controlled complex carbohydrates ,protein , fibre and fat , to break the sugar cycle and improve your symptoms .
Posted by cybercafe on June 1, 2003, at 4:17:53
In reply to Re: HPA, Atypicals and Opiates?--Cam?? » cybercafe, posted by MB on May 31, 2003, at 19:13:48
> I *have* read the reports about Parnate and insomnia, but after years on the med-go-round, I have become very careful to not equate "insomnia" or "activation" with "energizing." For example, Effexor gave me horrible insomnia, and it was extremely activating (in that I had to keep
like i can relate to that, in the initial stages my first time on effexor i felt drowsy if i took it in the morning but activated if i took it at night....
>agitated...anyway, that's my explanation for having misgivings about Parnate despite the insomnia reports.
nope i think most people find it very energizing
> That's great that you found it both stimulating and non-fatiguing. The only med I've found like that was Adderall. It gave me insomnia, but I didn't care, because there wasn't fatigue mixed with the insomnia. Maybe Parnate would be like this.
i would give it a try ...
> Well, I think you might be onto something regarding not noticing the fatigue due to busyness. When I'm up and moving, the fatigue is
definitely less. It's just hard to get up and moving. This Lexapro/Klonopin combo I'm on is very unmotivating. If I have an appointment where I'm *committed* to get off of my lazy butt, then the fatigue isn't so bad (but moving around *does* give me tachycardia and head-rushes). I guess its all about compromises (e.g. "Would I rather think of killing myself 24/7 or would I rather be numb, anhedonic, and amotivated?"). Recreational drugs are nice, but they quit working very quickly and then there are two problems: a mood disorder + a chemical dependency. Woa, I'm getting off topic, ramble, ramble, ramble...
well as for fatigue i'm a rather weird case.... SSRIs would probably not be noticeable compared to the fatigue attributed to benzos... plus i have ADHD and that is similiar to being understimulated i believe (hence clumsiness and other symptoms)
>
> > anyways.... yeah i would definately recommend MAOIs... they're great drugs
>
> My GP "doesn't prescribe" Parnate, and my pharmacy doesn't carry it. I've alienated myself from all the pdocs in my town because I'm a non-compliant know-it-all, so getting help from a psych professional isn't an option. I might have to go out of state.yeah i have come close to alienating all of my doctors... but not without good reason
Posted by jrbecker on June 1, 2003, at 11:24:42
In reply to Re: HPA aix and non-suppression » Shawn. T., posted by Pfinstegg on May 29, 2003, at 20:22:44
> Just to add my two cents worth, I'm mixed melancholic-atypical, but more atypical. I was a non-suppressor with a low-normal 24-hour cortisol; after TMS, I became a suppressor, and am trying hard to stay that way-for me, this coincided with a remission. (I'm female).
>
> PfinsteggI thought it was interesting to note that in the Gold/Chrousos meta-analysis study I cited before, only 25-30% of unipolar depressives are pure melancholic while another 15-30% present pure atypical features. The rest are mixed, but those that do feature more pure melancholic or atypical features show a much more severe course than those with mixed features.
Posted by MB on June 1, 2003, at 11:46:45
In reply to Re: HPA, Atypicals and Opiates?--Cam??, posted by cybercafe on June 1, 2003, at 4:17:53
> > My GP "doesn't prescribe" Parnate, and my pharmacy doesn't carry it. I've alienated myself from all the pdocs in my town because I'm a non-compliant know-it-all, so getting help from a psych professional isn't an option. I might have to go out of state.
>
> yeah i have come close to alienating all of my doctors... but not without good reasonYeah, I was being kinda sarcastic. Whenever I refuse a med due to side effects, or if I suggest something that they wouldn't have thought of (especially off-lable stuff) they usually get pissed. I'm not really into working with pdocs that hate me. One actually threw me out and fired me because I had been self-medicating with morphine. Didn't seem fair, but, oh well. Addicts need psychiatric care too. At least that's what I thought. I wonder what he would have done if I had gone out and topped myself. Irresponsible, I think.
MB
Posted by maryhelen on June 1, 2003, at 16:33:40
In reply to Re: HPA, Atypicals and Opiates?--Cam?? » cybercafe, posted by MB on June 1, 2003, at 11:46:45
I am absoultely stunned at the information presented in this post. It would tell me, like myself, you do the research and present it to your pdoc. Thank goodness mine is receptive to this. Others have never been. It is no wonder we have a hard time finding the right medication, if we ever do.
However, I am stymied now. I am on 90 mg of Parnate, which has worked well for me until 3 months ago. My doctor augmented it with Lithium.
Although I was getting an anti-depressant effect, the side effects were horrible. Tremors, twitching, hair loss, but most of all I was dull. I couldn't get things. I told him I was getting stupid. I couldn't type and I am a school secretary. I have been off work for 2 years and was just about to return. I could not go in like that. He then augmented it with Lamitcal. I have been on it a month and am now at 100 mg. I have never felt better, except for ongoing insomnia. I am addicted to all types of benzos, so I really just have to live with it. But reading other posts, I am so scared that it is going to poop out and I will be back at work going into the depression again.I agree 100% that opiates take away the depression. The problem for me was I became seriously addicted and when I didn't have them I crashed into the most severe, suicidal depression I have ever experienced. I needed more and more. Without really knowing the power of the last one I took, Dilaudid, which made me feel fantastic, the withdrawal put me in hospital again certified, to my 3rd substance abuse program and 2 years later still fighting the urge.
I found out that Dilaudid is 9 times the strength of morphine, used for people in the pain of last stages of cancer. The bad thing is for me is that I have serious back problems with constant pain and I can't take anything for it as the anti-inflamatories do not work.By the way, I have treatment resistant depression, no cycling. Is that the same as atypical depression.
Anyway, I am all confused.
maryhelen
Posted by MB on June 1, 2003, at 17:24:00
In reply to Re: HPA, Atypicals and Opiates?--Cam??, posted by maryhelen on June 1, 2003, at 16:33:40
Atypical Depression is they type where sufferers will sleep more and eat more when depressed. Mood might improve for a *short* time if something great happens (e.g., the man of your dreams calls for a date), but then it's right back into the dumps for the Atypicals. Atypical Depression is actually quite common, which is counterintuitive when you read the name. The other type of depression is where the person can't sleep, can't eat, loses a bunch of weight, etc. With this type of depression, the person probally wouldn't feel better (even for a short time) even if they won the lottery. That's called a lack of "mood reactivity." The Atypicals have *some* mood reactivity, while the others don't. Sometimes people with more typical symptoms are called "melancholic."
I hope that helps the confusion, and if I'm wrong about something, I hope the other posters will correct me.
Peace,
MB
Posted by jemma on June 1, 2003, at 19:25:49
In reply to Re: HPA, Atypicals and Opiates?--Cam??, posted by maryhelen on June 1, 2003, at 16:33:40
You might want to try melatonin, which I've found very effective for sleep. Or an over-the-counter antihistamine like gravol or benedryl. They should be pretty safe for someone in recovery, as they're mild and non-addictive.
- jemma
> I am absoultely stunned at the information presented in this post. It would tell me, like myself, you do the research and present it to your pdoc. Thank goodness mine is receptive to this. Others have never been. It is no wonder we have a hard time finding the right medication, if we ever do.
>
> However, I am stymied now. I am on 90 mg of Parnate, which has worked well for me until 3 months ago. My doctor augmented it with Lithium.
> Although I was getting an anti-depressant effect, the side effects were horrible. Tremors, twitching, hair loss, but most of all I was dull. I couldn't get things. I told him I was getting stupid. I couldn't type and I am a school secretary. I have been off work for 2 years and was just about to return. I could not go in like that. He then augmented it with Lamitcal. I have been on it a month and am now at 100 mg. I have never felt better, except for ongoing insomnia. I am addicted to all types of benzos, so I really just have to live with it. But reading other posts, I am so scared that it is going to poop out and I will be back at work going into the depression again.
>
> I agree 100% that opiates take away the depression. The problem for me was I became seriously addicted and when I didn't have them I crashed into the most severe, suicidal depression I have ever experienced. I needed more and more. Without really knowing the power of the last one I took, Dilaudid, which made me feel fantastic, the withdrawal put me in hospital again certified, to my 3rd substance abuse program and 2 years later still fighting the urge.
> I found out that Dilaudid is 9 times the strength of morphine, used for people in the pain of last stages of cancer. The bad thing is for me is that I have serious back problems with constant pain and I can't take anything for it as the anti-inflamatories do not work.
>
> By the way, I have treatment resistant depression, no cycling. Is that the same as atypical depression.
>
> Anyway, I am all confused.
>
> maryhelen
>
>
Posted by TapiocaMonk on June 1, 2003, at 22:08:01
In reply to Re: HPA, Atypicals and Opiates?--Cam?? » maryhelen, posted by jemma on June 1, 2003, at 19:25:49
So, is Parnate alone the optimal treatment for atypicals who haven't responded to any of the usual SSRI/TCA meds? What about augmenting Parnate w/another med?
Also, one thing I haven't seen mentioned anywhere is combining Parnate w/a stimulant. I know it is contraindicated, but I am in a medication study now on refractory depression, and if I don't respond to Parnate (doses up to 120mg), they will try augmenting it with dexadrine.
Adding a stimulant (dexadrine, ritalin/concerta) to Parnate (assuming that such a combination is safe), may be an interesting solution to the fatigue and carbo-cravings of Atypical if an MAOI alone can't handle it.
Posted by BekkaH on June 1, 2003, at 22:23:37
In reply to Re: HPA, Atypicals and Opiates?--Cam??, posted by TapiocaMonk on June 1, 2003, at 22:08:01
I took Parnate with Ritalin a long time ago, and it was safe. Of course, you must do it under the supervision of a physician and continue to follow the MAOI diet. The reason Ritalin was added to Parnate was that I had a paradoxical reaction to Parnate (I have paradoxical rxns. to many medications), and I had severe daytime sleepiness and "narcolepsy"-like attacks. I would get uncontrollable urges to sleep at the most inconvenient and dangerous times. When Ritalin was added, the daytime sleepiness stopped. I took only a tiny amount of Ritalin. It was either 2.5 mg twice a day or 5 mg twice a day. The addition of Ritalin also helped somewhat with re-setting my wacky circadian rhythms, which were severely exacerbated by Parnate alone. By the way, Parnate is one of the most dopaminergic medicines available, and it also suppresses REM sleep more than just about any other medication, and this can cause disruption of circadian rhythms and numerous other problems. Interestingly, it has been reported that some of the newer dopamine agonists that are being used for Parkinson's Disease also cause uncontrollable daytime sedation and sleep attacks.
Posted by TapiocaMonk on June 2, 2003, at 0:19:57
In reply to Re: HPA, Atypicals and Opiates?--TapiocaMonk, posted by BekkaH on June 1, 2003, at 22:23:37
That makes sense ... I have experienced a lot of fatigue on Parnate.
> I took Parnate with Ritalin a long time ago, and it was safe. Of course, you must do it under the supervision of a physician and continue to follow the MAOI diet. The reason Ritalin was added to Parnate was that I had a paradoxical reaction to Parnate (I have paradoxical rxns. to many medications), and I had severe daytime sleepiness and "narcolepsy"-like attacks. I would get uncontrollable urges to sleep at the most inconvenient and dangerous times. When Ritalin was added, the daytime sleepiness stopped. I took only a tiny amount of Ritalin. It was either 2.5 mg twice a day or 5 mg twice a day. The addition of Ritalin also helped somewhat with re-setting my wacky circadian rhythms, which were severely exacerbated by Parnate alone. By the way, Parnate is one of the most dopaminergic medicines available, and it also suppresses REM sleep more than just about any other medication, and this can cause disruption of circadian rhythms and numerous other problems. Interestingly, it has been reported that some of the newer dopamine agonists that are being used for Parkinson's Disease also cause uncontrollable daytime sedation and sleep attacks.
Posted by cybercafe on June 2, 2003, at 0:50:14
In reply to Re: HPA, Atypicals and Opiates?--Cam?? » cybercafe, posted by MB on June 1, 2003, at 11:46:45
> > > My GP "doesn't prescribe" Parnate, and my pharmacy doesn't carry it. I've alienated myself from all the pdocs in my town because I'm a non-compliant know-it-all, so getting help from a psych professional isn't an option. I might have to go out of state.
> >
> > yeah i have come close to alienating all of my doctors... but not without good reason
>
> Yeah, I was being kinda sarcastic. Whenever I refuse a med due to side effects, or if I suggest something that they wouldn't have thought of (especially off-lable stuff) they usually get pissed. I'm not really into working with pdocs that hate me. One actually threw me out and fired me because I had been self-medicating with morphine. Didn't seem fair, but, oh well. Addicts need psychiatric care too. At least that's what I thought. I wonder what he would have done if I had gone out and topped myself. Irresponsible, I think.
>
> MB
>
>
>my problems mainly stemmed from docs who would tell me i'm alright, i should go get a job... yeah right!
Posted by Pfinstegg on June 2, 2003, at 11:37:22
In reply to Re: HPA aix and non-suppression » Pfinstegg, posted by jrbecker on June 1, 2003, at 11:24:42
I thought that was interesting, too- that being purely atypical or melancholic are more severe types of depression than having a mixture of symptoms. It does make sense, though, when you look at the chart of CNS functioning for the two types. The "pure" types had either a much more overactive HPA axis (melancholic), or a more over-suppressive frontal region (atypical), while the mixed syndromes probably have less abnormal brain function. I didn't know any of this.
I'm so glad you posted that article. It was one of the most informative i have ever read, particularly because it places the HPA axis in context with the frontal lobes, amygdala, etc.
As you learn more, I hope you will keep sharing your knowledge - I feel certain that I am not alone in finding it extremely valuable. And thanks!
Pfinstegg
Posted by jrbecker on June 3, 2003, at 23:12:03
In reply to Re: HPA aix and non-suppression » jrbecker, posted by Pfinstegg on June 2, 2003, at 11:37:22
As an addendum to the discussion before about the role of CRF and atypical depression. I found this to be interesting...
http://www.acnp.org/g5/p/SCH7_91-108.pdf
"Non-peptide CRF-binding Protein Ligand Inhibitors
As mentioned above, the CRF-binding protein has the capacity to bind and functionally inactivate CRF. Peptide CRF-BP ligand inhibitors release CRF from the binding protein, making it available for binding to its receptor. These inhibitors have been theorized to have efficacy in diseases that are associated with low levels of CRF, such as Alzheimer's disease (6). Interestingly, in contrast to the direct i.c.v. administration of CRF, inhibition of the CRF-BP by ligand inhibitors that release functional CRF does not cause anxiogenic-like activity in animal models, validating the approach for diseases that require an increase in CRF function (6). Thus, compounds that dissociate CRF from its binding protein complex will selectively increase synaptic concentrations of CRF in discrete brain regions and may provide a novel treatment opportunity for disorders associated with low levels of CRF. To date however, no non-peptide CRF-BP ligand inhibitors have been discovered to test this hypothesis."
So it seems that there has been some sort of proposed mechanism of action for treating underactive corticotropin-releasing factor output. Unfortunately, we'll have to wait for the engineering of such a compound before it can be determined what role it will have in benefiting conditions such as atypical depression, alzheimer's, etc.
Posted by dem on October 5, 2004, at 12:46:14
In reply to Re: You CANNOT lower CORTISOL directly, posted by jrbecker on May 26, 2003, at 12:22:37
I think im a good candidate for HPA axis / CRF therapies.
1) what is the agent that will most likely hit the market first ... and when ?
2) are there any opportunities to get involves with pre-release trials ?
Posted by Elroy on March 19, 2005, at 12:36:46
In reply to CORTISOL focused antidepressants, posted by dem on October 5, 2004, at 12:46:14
Good luck with getting an answer to this one....
It's actually the Psychiatric field - which seems to be much more limited - that is at the forefront of the clinical studies involving this concept. The Big Pharms don't seem to be that interested (yet) and they are the ones with the cash to do the big double-blind studies with placebos, etc.
Do a search (Google, Yahoo, whatever) with the phrase "depression" and "RU486" and "cortisol".
Check out how far back some of these studies go... 1999?
> I think im a good candidate for HPA axis / CRF therapies.
>
> 1) what is the agent that will most likely hit the market first ... and when ?
>
> 2) are there any opportunities to get involves with pre-release trials ?
This is the end of the thread.
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