Psycho-Babble Medication Thread 888716

Shown: posts 1 to 11 of 11. This is the beginning of the thread.

 

Jereon.....Check This Out

Posted by bleauberry on April 4, 2009, at 20:23:09

The below information is from year 2000. The drug is now in use, not experimental anymore.

Any which way you read it, there are two points in it that I've been pounding my fists about for months now and seems to go unheard.

1. The cortisol link to psychotic depression.
2. The use of both antidepressants and antipyschotics at the same time for psychotic depression, most especially the TCAs. There is enough evidence on this at pubmed to not ignore it any longer.

I didn't copy it here because it was too long, but I saw information on how Seroquel lowers cortisol significantly. Maybe that's how it worked for you? Maybe that effect couldn't hold, or the receptors readjusted, or something? And that was the poopout. And since you have this terrible reaction to high doses, there again, I can't help but see cortisol/adrenaline screaming all over it. The side effects you've mentioned, ya know?

An abortion pill to cure psychotic depression? Well, maybe so. Read on.
----------------------------------------------------

Stanford Report, November 8, 2000
RU-486 may dramatically relieve psychotic depression
BY CHARLES CLAWSON

Preliminary trials suggest that the controversial drug RU-486, a recently approved abortifacient and emergency contraceptive, may provide sudden relief for psychotic depression, a disease normally very difficult to treat. Related findings suggest that hydrocortisone may also speed up treatment of non-psychotic depression.

"Some psychotically depressed patients are dramatically better within a few days," said Alan Schatzberg, MD, Kenneth T Norris Junior Professor and chairman of the department of psychology and behavioral sciences at Stanford. "They stop hearing voices and having pessimistic kinds of delusions, like they're dying or the world is ending. We've seen the response within a four-day study. This is fairly dramatic."

Traditionally, patients with psychotic depression receive one of two treatments: an anti-depressant administered in conjunction with an anti-psychotic drug, or electro convulsive therapy (ECT). Even when effective, both treatments are relatively slow, and can leave residual symptoms that last for months.

"With mifepristone (RU-486) there's a very quick intervention, the patients often feel better, and then we can put them on conventional anti-depressants without the anti-psychotics or ECT," Schatzberg said. "What's interesting is that the results are not effervescent. The patients feel better and it lasts. Nobody's had to come back, nobody's had to undergo ECT." The social implications of the treatment are profound, Schatzberg said, both because mifepristone might eliminate the need for shock treatments and because it comes from a drug with other uses that some people don't like.

Originally mifepristone was developed as a steroid treatment for Cushing's disease, to block the adrenal hormone cortisol. But since progesterone receptors and cortisol receptors are structurally related, mifepristone also blocks progesterone, an effect that makes it useful as an abortifacient and, in smaller doses, as an emergency contraceptive.

Research over the last 17 years has revealed that cortisol is extremely elevated in psychotically depressed patients. As a "stress" hormone, cortisol is released during times of significant stress as part of humans' "fight or flight" behaviors. In psychotic depression, the natural feedback loop involving cortisol is thought to be awry, with sustained levels of the hormone creating a chronic stress reaction. This in turn may cause the serious symptoms of psychotic depression, including hallucinations, sleep disturbances and memory problems.

"We believe that the cortisol receptor is involved in the cognitive problems of severely depressed patients, particularly those with psychosis," said Schatzberg. "And so blocking those receptors, we think, may be associated with a relatively rapid response to treatment."

In a preliminary trial, five psychotically depressed patients were treated with mifepristone and four showed marked improvement within about four days. Further studies are now underway and in need of volunteers.

One study, being conducted in conjunction with the company Corcept, tests dosing levels of mifepristone for psychotic depression. Over the next year, 70 patients will be studied upon receiving mifepristone for about a week.

"Usually we get a good sense after a week whether mifepristone's going to be useful or not," said Charles DeBattista, MD, assistant professor of psychiatry and director of the Depression Research Clinic. "For some patients it's been dramatically helpful in two or three days. For instance, one gentleman went from being severely depressed, with suicidal thoughts, severe fatigue, daily hallucinations, hearing voices that wouldn't stop, to being free of all those symptoms within a week. It's happened enough that we're pretty excited."

A second trial underway, also involving mifepristone, is designed to shed light on the biologic basis of psychotic depression, as distinguished from milder or non-depressive states.

About 90 patients will be studied over five years -- 30 individuals each from the psychotically depressed, non-psychotically depressed, and control categories. The landmark study, funded by the NIH, should provide crucial data for differentiating psychotic and non-psychotic depressions, which are thought to be distinct illnesses. As many as 15% of depressed patients suffer psychotic depression.

In the study, only psychotically depressed patients will receive mifepristone. Non-psychotically depressed patients will be eligible to participate in a second phase of the trial, testing whether the administration of hydrocortisone speeds up the response of a standard anti-depressant called Effexor. "One of our earlier studies suggested that non-psychotically depressed patients can have a rapid improvement in symptoms just with the administration of hydrocortisone," said DeBattista. The trial will be the first of its kind to study whether something as common as hydrocortisone can speed up response to anti-depressants.

"These are really innovative studies that may greatly impact the way we treat depression in the future," DeBattista added. Volunteers who feel they may qualify for the study as depressed or psychotically depressed individuals and are interested in participating should contact the Depression Research Clinic at (650) 725-4620 for an initial over-the-phone assessment.

Along with Schatzberg and DeBattista, the depression group includes Joseph Belanoff, a Stanford postdoctoral fellow working with Corcept; Steve Lindley, MD, PhD, clinical instructor in psychiatry at the Palo Alto VA; David Lyons, PhD, associate professor at the Stanford Primate Center; and psychiatry fellows Ben Flores, MD, and Shelly Flemming, PhD.

 

Re: Jereon.....Check This Out » bleauberry

Posted by Phillipa on April 5, 2009, at 0:18:14

In reply to Jereon.....Check This Out, posted by bleauberry on April 4, 2009, at 20:23:09

BB please don't confuse Jeroen. Thanks Phillipa

 

Re: Jereon.....Check This Out » Phillipa

Posted by yxibow on April 5, 2009, at 5:27:07

In reply to Re: Jereon.....Check This Out » bleauberry, posted by Phillipa on April 5, 2009, at 0:18:14

> BB please don't confuse Jeroen. Thanks Phillipa

I don't know about confusing, but this is still under research even 9 years after this old article was published. There isn't clear large scale studies about cortisol and psychotic depression or other related disorders,

e.g.

http://www.nature.com/npp/journal/v31/n3/abs/1300884a.html

-- Jay

 

Re: Jereon.....Check This Out » yxibow

Posted by bleauberry on April 5, 2009, at 6:18:47

In reply to Re: Jereon.....Check This Out » Phillipa, posted by yxibow on April 5, 2009, at 5:27:07

> > BB please don't confuse Jeroen. Thanks Phillipa

It's pretty straight forward and Jereon despite the illness seems to be intelligent.

>
> I don't know about confusing, but this is still under research even 9 years after this old article was published. There isn't clear large scale studies about cortisol and psychotic depression or other related disorders,
>
> -- Jay
>

True enough. That can be said about any psychiatric disorder. No one can prove depression is low serotonin, and even if they could, they can't even measure it accurately without doing a spinal tap or a brain biopsy. Same with other disorders. They are all theories that are the best we have at this time, better than nothing, but cannot be replicated reliably over and over...which makes them non-facts.

Same with the meds. If one is to include the failed studies that were not presented to FDA for med approval, the so-called response rates would be considerably lower than they appear. Not to mention the cherry-picked patients when meds are studied. On and on. Don't get me going on that topic.

What I am saying is, it is made to sound like everything we deal with here in the psychiatry world is well studied and proven. None of it is. Sure, millions of hours and dollars are indeed spent, but the results are not much more clear now than 50 years ago.

All that said, Jereon has already valiantly patiently been through the best of the best that our science and studies shave to offer. Now being considered are weird "unproven" things like Memantine and other oddball approaches. One of them could be a miracle I have no doubt. But none are well studied, even years later, none are proven, and none are commonplace.

That's why when it comes to Jereon, I keep my eyes open for the other trees in the forest that we didn't see at first glance. When doing that, I see studies at pubmed where TCAs with antipsychotics worked on people with similar histories and Jereon. I stumble onto things like these observations concerning excess-cortisol, another one about seroquel lowering cortisol, and such, and start putting pieces of a theoretical puzzle together.

Jereon is way past anything that routine or protocol medicine has to offer. When things that are supposed to work don't, I think it is wise to reconsider the diagnosis, and reconsider other angles. The human body is so complicated that anyone who stays voluntarily within a confined pattern of thinking is limiting opportunity.

The observations presented were real. They happened. Doesn't matter if they are controversial, uncommon, or mysterious. They happened. They happened with enough robustness to surprise the clinicians in charge.

All I'm saying is Jereon won't get well on purer antipsychotics. Why? Been there, done that, all of them, combinations, even the gold standards. One at that point has to consider anecdotal cases, pioneering cases, and abstract cases as part of their armament against disease.

 

BB

Posted by Jeroen on April 5, 2009, at 16:45:53

In reply to Re: Jereon.....Check This Out » yxibow, posted by bleauberry on April 5, 2009, at 6:18:47

thanks, ill investigate this

 

BB

Posted by Jeroen on April 5, 2009, at 16:49:05

In reply to Jereon.....Check This Out, posted by bleauberry on April 4, 2009, at 20:23:09

http://74.125.77.132/search?q=cache:6inLxgaLnT0J:www.journals.elsevierhealth.com/periodicals/bps/article/PIIS0006322304010972/fulltext+mifepristone+schizophrenia&cd=2&hl=nl&ct=clnk&gl=be

hi read this, this one had a negative outcome

 

how much mg do i need to take of this?

Posted by Jeroen on April 5, 2009, at 16:50:40

In reply to Jereon.....Check This Out, posted by bleauberry on April 4, 2009, at 20:23:09

how much mg do i need to take of this?

 

Re: how much mg do i need to take of this? » Jeroen

Posted by bleauberry on April 5, 2009, at 17:11:12

In reply to how much mg do i need to take of this?, posted by Jeroen on April 5, 2009, at 16:50:40

> how much mg do i need to take of this?

I actually don't know any more than what you and I have both seen in this thread. It might be possible to print up stuff on the topic, print stuff on the topic of seroquel and cortisol, and present what you find to the doctors. Then ask them to do a cortisol workup on you, preferably with at minimum a morning test and a night test, but better would be 4 tests througout a day. That help determine whether this approach should even be on the table or not.

The more straight forward thing I've mentioned a few times is to combine a tricyclic antidepressant with your seroquel. I would think either amitriptyline, nortriptyline, desipramine, or if you think you can handle the blurry eyes, dry mouth, and constipation stuff, go for the king clomipramine which has some 5ht2 action different than the others. I only mention these because of anecdotal stuff I've seen at pubmed and other places. No hard science. You've already been through all that. I just keep an eye out when I'm surfing for things that have worked for other people with treatment resistant psychosis or psychotic depression. The TCA+antipsychotic combo came up a few times.

Back to the cortisol thing, I know most of the benzos dampen down cortisol. I wonder if you've ever tried Klonopin or Lorazepam? Even though they are usually not thought of in terms of psychosis, my hunch is they could do some good. But if you've already tried them and had bad reactions, forget I said anything. :-)

 

Re: Jereon.....Check This Out » bleauberry

Posted by bleauberry on April 5, 2009, at 17:15:58

In reply to Jereon.....Check This Out, posted by bleauberry on April 4, 2009, at 20:23:09

Something I forgot to mention...

Are you on generic Seroquel or the real stuff?

Ya know, seriously, no kidding, if you are on generic, you should strongly insist on a 2 week trial of the authentic brand just to see what happens. More than a few people have noticed a significant difference between the generic and brand Seroquel. That would make a lot more sense, and be a lot easier to do, than adding in a completely different medicine. At least try it. If you are already on the brand, not generic, well, it was a benevolent thought on my part and please disregard. :-)

 

Re: Jereon.....Check This Out » bleauberry

Posted by yxibow on April 6, 2009, at 4:59:07

In reply to Re: Jereon.....Check This Out » bleauberry, posted by bleauberry on April 5, 2009, at 17:15:58

> Something I forgot to mention...
>
> Are you on generic Seroquel or the real stuff?
>
> Ya know, seriously, no kidding, if you are on generic, you should strongly insist on a 2 week trial of the authentic brand just to see what happens. More than a few people have noticed a significant difference between the generic and brand Seroquel. That would make a lot more sense, and be a lot easier to do, than adding in a completely different medicine. At least try it. If you are already on the brand, not generic, well, it was a benevolent thought on my part and please disregard. :-)


First of all where the generic is made varies by country, and I believe Jeroen was going to try Seroquel XR.

There's too many possible experiments going on in my opinion -- I still emphatically say if there's going to be a trial of a medication, wait two weeks or a month.

I'm sorry if I'm a little sharp, but from what I've seen there's been a lot of merry-go-round of medication and that just cannot be good for successful treatment in my opinion.

-- Jay

 

seroquel

Posted by Jeroen on April 7, 2009, at 5:45:37

In reply to Re: Jereon.....Check This Out » bleauberry, posted by yxibow on April 6, 2009, at 4:59:07

the brand, not generic, i never taken the generic


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