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Dr. Bob is Robert Hsiung, MD,
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Posted by bulldog2 on April 27, 2010, at 10:51:27
In reply to Re: Prednisone and Immediate AD Response » bulldog2, posted by SLS on April 27, 2010, at 9:51:33
> Hi Bulldog.
>
> > Some alt health docs use low dose cortisone for depression.
>
> What dosages are used?
>
>
> - ScottThey usually use hydrocortisone which is much weaker than the synthetic prenisone. They use doses in the ranges of 5 - 20 mg and one of the brand names used is cortef.
Please disregard Phillip's post. She is referring to very high dose prednisone over long periods which can be dangerous.
The dose of hydrocortisone (natural cortisone) which is 5 - 20 mg is equivalent to 1 to 5 mg of prednisone. If there is adrenal fatigue there is usually a fast and dramatic response in terms of mood and energy.
Once the adrenals are refreshed is a good time to do blood work on the thyroid. It's like the domino effect. When the adrenals are exhausted the production of other hormones suffer and once they are refreshed ther other hormones can be produced.
Actually a simple enough test to do if you can find cortef.
Posted by SLS on April 27, 2010, at 12:52:18
In reply to Re: Prednisone and Immediate AD Response, posted by bulldog2 on April 27, 2010, at 10:51:27
How do you think this figures in?
I'm having a hard time understanding this stuff.
Is your baseline cortisol level high or low?
My baseline salivary cortisol is high and I am a dexamethasone non-suppressor.
I tried a one-week treatment using mifepristone. It didn't help. However, I felt sort of washed-out afterwards. Do you think this was from adrenal exhaustion? I don't know.
- Scott
--------------------------------------------------
Antidepressant treatment with mirtazapine, but not venlafaxine, lowers cortisol concentrations in saliva: A randomised open trialBarbara ScharnholzaCorresponding Author Informationemail address, Bettina Weber-Hamannb, Florian Lederbogena, Claudia Schillinga, Maria Gillesa, Vera Onkena, Pascal Frankhauserc, Daniel Kopfd, Michael Deuschlea
Received 4 January 2009; received in revised form 17 August 2009; accepted 26 August 2009.
AbstractLowering the concentrations of free cortisol in depressed patients may be an important prerequisite to prevent glucocorticoid-related sequelae of depression. We tested the hypothesis that the hypothalamuspituitaryadrenal (HPA) system-dampening effects of venlafaxine and mirtazapine differ. We compared the course of morning (08.00h) and afternoon saliva cortisol (16.00h) in 42 mirtazapine- and 45 venlafaxine-treated depressed patients during a 1-week wash-out and a 4-week treatment period in a randomised open trial. Mirtazapine lowered afternoon cortisol from week 1 to 4. In contrast, during the course of the entire treatment period, venlafaxine did not attenuate saliva cortisol concentrations. Treatment effects of mirtazapine on cortisol concentrations did not differ in remitters and non-remitters to treatment. High baseline cortisol concentrations, on the other hand, were related to an unfavourable course during venlafaxine treatment and patients remitting during venlafaxine treatment had significantly lower afternoon cortisol concentrations in saliva, when compared to non-remitting patients. Thus, mirtazapine and venlafaxine show different effects on HPA system activity as measured by saliva cortisol. This may be of relevance with regard to physical sequelae of depression
--------------------------------------------------
Posted by bulldog2 on April 27, 2010, at 14:05:30
In reply to Re: Prednisone and Immediate AD Response » bulldog2, posted by SLS on April 27, 2010, at 12:52:18
> How do you think this figures in?
>
> I'm having a hard time understanding this stuff.
>
> Is your baseline cortisol level high or low?
>
> My baseline salivary cortisol is high and I am a dexamethasone non-suppressor.
>
> I tried a one-week treatment using mifepristone. It didn't help. However, I felt sort of washed-out afterwards. Do you think this was from adrenal exhaustion? I don't know.
>
>
> - Scott
>
>
> --------------------------------------------------
>
>
> Antidepressant treatment with mirtazapine, but not venlafaxine, lowers cortisol concentrations in saliva: A randomised open trial
>
> Barbara ScharnholzaCorresponding Author Informationemail address, Bettina Weber-Hamannb, Florian Lederbogena, Claudia Schillinga, Maria Gillesa, Vera Onkena, Pascal Frankhauserc, Daniel Kopfd, Michael Deuschlea
>
> Received 4 January 2009; received in revised form 17 August 2009; accepted 26 August 2009.
> Abstract
>
> Lowering the concentrations of free cortisol in depressed patients may be an important prerequisite to prevent glucocorticoid-related sequelae of depression. We tested the hypothesis that the hypothalamuspituitaryadrenal (HPA) system-dampening effects of venlafaxine and mirtazapine differ. We compared the course of morning (08.00h) and afternoon saliva cortisol (16.00h) in 42 mirtazapine- and 45 venlafaxine-treated depressed patients during a 1-week wash-out and a 4-week treatment period in a randomised open trial. Mirtazapine lowered afternoon cortisol from week 1 to 4. In contrast, during the course of the entire treatment period, venlafaxine did not attenuate saliva cortisol concentrations. Treatment effects of mirtazapine on cortisol concentrations did not differ in remitters and non-remitters to treatment. High baseline cortisol concentrations, on the other hand, were related to an unfavourable course during venlafaxine treatment and patients remitting during venlafaxine treatment had significantly lower afternoon cortisol concentrations in saliva, when compared to non-remitting patients. Thus, mirtazapine and venlafaxine show different effects on HPA system activity as measured by saliva cortisol. This may be of relevance with regard to physical sequelae of depression
>
>
> --------------------------------------------------
>
>Scott
Your questions are past my understanding. I believe my urine 24 hour cortisol levels were normal. But this doesn't take into account ebbs and flows.
I think the test using hydrocortisone is more looking at clinical results rather than lab values. You take hydrocortisone starting at 5mg and if no result 10 mg and go as high as 20 mg. If you feel better you probably have adrenal fatigue.
Adrenal fatigue happens in two stages. In the first stage your cortisol levels would be high as stress causes your body to produce more cortisol. In the final stage your cortisol levels would be low as your adrenals are now exhaused. Whatever stage of adrenal fatigue your body is in the extra hydrocortisone would relieve the burden.
Posted by SLS on April 27, 2010, at 15:53:01
In reply to Re: Prednisone and Immediate AD Response, posted by bulldog2 on April 27, 2010, at 14:05:30
> Adrenal fatigue happens in two stages. In the first stage your cortisol levels would be high as stress causes your body to produce more cortisol. In the final stage your cortisol levels would be low as your adrenals are now exhaused. Whatever stage of adrenal fatigue your body is in the extra hydrocortisone would relieve the burden.
Good explanation.
Thanks.
- Scott
Posted by bulldog2 on April 27, 2010, at 18:01:22
In reply to Re: Prednisone and Immediate AD Response » bulldog2, posted by SLS on April 27, 2010, at 15:53:01
> > Adrenal fatigue happens in two stages. In the first stage your cortisol levels would be high as stress causes your body to produce more cortisol. In the final stage your cortisol levels would be low as your adrenals are now exhaused. Whatever stage of adrenal fatigue your body is in the extra hydrocortisone would relieve the burden.
>
> Good explanation.
>
> Thanks.
>
>
> - ScottScott
One more point. When your body is preoccupied with making cortisol the adrenals cannot make suffucient amount of other hormones that it usually makes. When you throw in exogenous cortisone it cannot recognize the source but knows the body has enough cortisol and can now make other hormones the body needs.
Now not eveyone turns out to be suffering from adrenal fatigue and do not feel better when given extra hydrocortisone. So they have to look elsewhere for the source of their depression.
I don't know if you've seen studies that autopsies of depressed people revealed many cases of adrenal hypertrophy.
I would believe that enlarged adrenals would point to damaged adrenals that probably will never be totally repaired to their original state. I doubt that cbt or alt medicine can fix a problem such as this. It would seem this is a condition similar to diabetes that would require lifelong intervention. I don't know if current antidepressants can do the job. Possibly damaged adrenals causing depression will require lifelong hormonal balancing. The current antidepressant merry go round that p-docs engage in needs to be replaced with a meaningful system of medical detective work that will find the source of the disease and the best response available.
Posted by Phillipa on April 27, 2010, at 19:17:14
In reply to Re: Prednisone and Immediate AD Response » SLS, posted by bulldog2 on April 27, 2010, at 18:01:22
Bulldog please don't speak for me thank you. Phillipa ps I have no idea of the dose. But do know medrol as have taken myself. No effect at all. My sister reacts differently.
Posted by Phillipa on April 27, 2010, at 19:33:43
In reply to Prednisone and Immediate AD Response, posted by bulldog2 on April 26, 2010, at 14:14:44
Here's an informative link on medrol packs. Seems it's good for rheumatoid arthritis. Phillipa many side effects noted.
Posted by desolationrower on April 27, 2010, at 22:15:49
In reply to Prednisone and Immediate AD Response, posted by bulldog2 on April 26, 2010, at 14:14:44
cortisol can start off ok, but turn dysphoric
theres a lot on hpta axis and depression
-d/r
Posted by ed_uk2010 on April 28, 2010, at 14:53:37
In reply to Re: Prednisone and Immediate AD Response, posted by SLS on April 26, 2010, at 16:06:36
>Prednisone is well known to produce psychiatric side effects ranging from depression to mania.
Absolutely. Long-acting corticosteroids such as dexamethasone also cause insomnia very frequently.
I think it's fair to say that many of the people who initially experience a mood lift on prednisone end up feeling quite depressed a few weeks down the line.
Posted by bulldog2 on April 28, 2010, at 15:21:06
In reply to Re: Prednisone and Immediate AD Response, posted by Phillipa on April 27, 2010, at 19:33:43
> Here's an informative link on medrol packs. Seems it's good for rheumatoid arthritis. Phillipa many side effects noted.
>
> http://www.drugs.com/pro/medrol.htmlPhillipe you totally missed the point as usual. We are talking of low dose hydrocortisone for adrenal fatigue. It's the natural form as our body makes and a much lower dose than a medrol pack. I did comment on a medrol pack for me.But for adrenal fatigue we were talking of hydrocortisone. The doses we were talking about are equivalent to 1-5 mg of prednisone.
You are always jumping in with stories of terrible side effects not matter what the topic is. But what you often fail to factor in is dose related.
I know you once mentioned the disease your mother had. Maybe addison's. The doses of prednisone to treat that would be high and would eventually cause severe side effects in most people. We were talking of mini doses of hydrocortisone.
Your remark was not correct for doses used for adrenal fatigue. It's like hormone replacement. If done correctly one should feel better and not have bad sides.
Posted by bulldog2 on April 28, 2010, at 15:28:42
In reply to Re: Prednisone and Immediate AD Response » SLS, posted by ed_uk2010 on April 28, 2010, at 14:53:37
> >Prednisone is well known to produce psychiatric side effects ranging from depression to mania.
>
> Absolutely. Long-acting corticosteroids such as dexamethasone also cause insomnia very frequently.
>
> I think it's fair to say that many of the people who initially experience a mood lift on prednisone end up feeling quite depressed a few weeks down the line.
>
>To desolation and Ed
The adrenal fatigue part of this thread is not done with prednisone. Please go back and read. I said I used pred. But when I talked about adrenal fatigue with Scott I mentioned hydrocortisone. That is basically the form the body makes and is much gentler than prednisone. Now go back and reread what I wrote to Scott. HYDROCORTISONE. Also supplemented in small amounts as if doing hormone balancing. In the Yeast Connection it is mentioned as an alternative way of correcting adrenal fatigue. If done correctly can be done long term. Can also be adjusted as the adrenals correct themselves.
Posted by bleauberry on April 28, 2010, at 18:30:43
In reply to Prednisone and Immediate AD Response, posted by bulldog2 on April 26, 2010, at 14:14:44
I just wanted to say I'm impressed.
Up to this point I thought I was the only one around here that knew anything about adrenal fatigue and the whole cortisol connection to neurotransmitter function.
I feel like such a weirdo outsider sometimes talking stuff no one knows about, not even their doctors. But every now and then, someone comes along and says it better than I ever did.
Thanks for the thread here. Very informative for those who don't know.
Posted by sigismund on April 28, 2010, at 18:46:08
In reply to Re: Prednisone and Immediate AD Response » SLS, posted by ed_uk2010 on April 28, 2010, at 14:53:37
>Long-acting corticosteroids such as dexamethasone also cause insomnia very frequently.
So do you think that beclamethosone dipropionate (from Becanase Aq) could do the same?
Doctors and pharmacists sometimes say (patronisingly, I feel) that the drug is not absorbed systemically.
Posted by bulldog2 on April 28, 2010, at 18:59:16
In reply to Re: Prednisone and Immediate AD Response » bulldog2, posted by bleauberry on April 28, 2010, at 18:30:43
> I just wanted to say I'm impressed.
>
> Up to this point I thought I was the only one around here that knew anything about adrenal fatigue and the whole cortisol connection to neurotransmitter function.
>
> I feel like such a weirdo outsider sometimes talking stuff no one knows about, not even their doctors. But every now and then, someone comes along and says it better than I ever did.
>
> Thanks for the thread here. Very informative for those who don't know.Hi Bleauberry
Yes I've been aware of the adrenal/cortisol connection since I read the book called the "yeast Connection". I've believed for years that stress leads to fatigued adrenals leads to depression. Now I'm not saying all depression but possibly a big player in a lets say a majority of depressions. The fact that anti depressants work at all is probably due to blocking the reuptake of norepinephrine and eventual down regulation of their receptors. This lets the adrenals get rested. The old tcas are primarily ne reuptake blocker. Not sure how the ssris affect the adrenals. Welcome to the rested adrenal/cortisol connection.
Posted by Phillipa on April 28, 2010, at 19:51:07
In reply to Re: Prednisone and Immediate AD Response » bleauberry, posted by bulldog2 on April 28, 2010, at 18:59:16
Adrenal fatique can heal on own by sleeping the repair work is from 10pm to 2am I believe. I can google. Phillipa
Posted by Phillipa on April 28, 2010, at 20:03:03
In reply to Re: Prednisone and Immediate AD Response » bleauberry, posted by bulldog2 on April 28, 2010, at 18:59:16
Well here's a natural site to healing the addrenals in adrenal fatigue. Phillipa
Posted by hopefullynow on April 29, 2010, at 0:32:16
In reply to Re: Prednisone and Immediate AD Response » bleauberry, posted by bulldog2 on April 28, 2010, at 18:59:16
Bulldog, Bleauberry,
I agree, after years of stress caused by anxiety, sleep problems, some of us have serious issues with adrenals, it's quite obvious since they pump adrenaline and cortisol uncontrolable for so long and HPA axis is disregulated, they tend to burn out.I always "cycled" in a way that adrenals were on fire due to anxiety to the roof for a few days then one week of total lethargy, felling drained, depressed and dysphoric.Once I stopped this go-up go-down i have been left with weak adrenals which under stres (psychological, or physiological) tend to burn out in normal conditions of every day life.Every time, i supplement my AD coctail with tiny amounts of prednisone, everything is going back to normal, my energy restores, my mood balances and i feel absolutely normal, no more "cycling".Indeed these tiny amounts of prednisone (hydrocortisone no available - just injectable)do their job, restoring my natural energy levels, sleep pattern and mood.
Posted by morganator on April 29, 2010, at 1:10:25
In reply to Re: Prednisone and Immediate AD Response » bulldog2, posted by bleauberry on April 28, 2010, at 18:30:43
BB, you should check out Mind and Muscle.
Posted by morganator on April 29, 2010, at 1:13:18
In reply to Re: Prednisone and Immediate AD Response, posted by hopefullynow on April 29, 2010, at 0:32:16
> Bulldog, Bleauberry,
> I agree, after years of stress caused by anxiety, sleep problems, some of us have serious issues with adrenals, it's quite obvious since they pump adrenaline and cortisol uncontrolable for so long and HPA axis is disregulated, they tend to burn out.I always "cycled" in a way that adrenals were on fire due to anxiety to the roof for a few days then one week of total lethargy, felling drained, depressed and dysphoric.Once I stopped this go-up go-down i have been left with weak adrenals which under stres (psychological, or physiological) tend to burn out in normal conditions of every day life.
>
> Every time, i supplement my AD coctail with tiny amounts of prednisone, everything is going back to normal, my energy restores, my mood balances and i feel absolutely normal, no more "cycling".Indeed these tiny amounts of prednisone (hydrocortisone no available - just injectable)do their job, restoring my natural energy levels, sleep pattern and mood.Do you take small doses of Prednisone on a daily or regular basis? Or do you just take it when you feel a need for it?
Posted by hopefullynow on April 29, 2010, at 7:16:11
In reply to Re: Prednisone and Immediate AD Response, posted by morganator on April 29, 2010, at 1:13:18
Hy,
I take small amounts (2.5-5 mg)when I need it, generally after 3-4 days off, i need to take prednisone one or two days consecutively, to allow my adrenals to recover.> Do you take small doses of Prednisone on a daily or regular basis? Or do you just take it when you feel a need for it?
Posted by bulldog2 on April 29, 2010, at 10:01:49
In reply to Re: Prednisone and Immediate AD Response, posted by morganator on April 29, 2010, at 1:13:18
> > Bulldog, Bleauberry,
> > I agree, after years of stress caused by anxiety, sleep problems, some of us have serious issues with adrenals, it's quite obvious since they pump adrenaline and cortisol uncontrolable for so long and HPA axis is disregulated, they tend to burn out.I always "cycled" in a way that adrenals were on fire due to anxiety to the roof for a few days then one week of total lethargy, felling drained, depressed and dysphoric.Once I stopped this go-up go-down i have been left with weak adrenals which under stres (psychological, or physiological) tend to burn out in normal conditions of every day life.
> >
> > Every time, i supplement my AD coctail with tiny amounts of prednisone, everything is going back to normal, my energy restores, my mood balances and i feel absolutely normal, no more "cycling".Indeed these tiny amounts of prednisone (hydrocortisone no available - just injectable)do their job, restoring my natural energy levels, sleep pattern and mood.
>
> Do you take small doses of Prednisone on a daily or regular basis? Or do you just take it when you feel a need for it?I would only take it every day if a doctor was regulating my cortisone intake. Like any hrt it needs to be monitored. However I have taken it now and than when I really need a boost. If hormones are a pyramid than cortisol is at the bottom. If that is out of whack more than likely the rest are also. The old domino effect.
Some alt med practicianers are aware of this but most convential docs are totally in the dark on this issue.
Posted by ed_uk2010 on April 30, 2010, at 14:30:46
In reply to Re: Prednisone and Immediate AD Response » ed_uk2010, posted by sigismund on April 28, 2010, at 18:46:08
>Doctors and pharmacists sometimes say (patronisingly, I feel) that the drug is not absorbed systemically.
Hi Sigi,
Beconase does not generally cause any systemic side effects. Only a tiny fraction of the dose is absorbed from the nose, but it is absorbed from the intestine after draining from the nose into the throat and being swallowed.
Once the drug has been absorbed, it is very rapidly metabolised and cleared from the body. The result of this is that standard therapeutic doses do not normally cause any side effects apart from local reactions eg. nasal dryness.
Posted by sigismund on May 2, 2010, at 3:03:30
In reply to Re: Prednisone and Immediate AD Response » sigismund, posted by ed_uk2010 on April 30, 2010, at 14:30:46
>Only a tiny fraction of the dose is absorbed from the nose, but it is absorbed from the intestine after draining from the nose into the throat and being swallowed.
Eddy, do you *know* this?
I mean, cocaine is well absorbed from the nose.
Is Becanase different?
Posted by ed_uk2010 on May 2, 2010, at 6:54:34
In reply to Re: Prednisone and Immediate AD Response » ed_uk2010, posted by sigismund on May 2, 2010, at 3:03:30
> Eddy, do you *know* this?
>
> I mean, cocaine is well absorbed from the nose.
>
> Is Beconase different?Yes, beclometasone dipropionate has different physico-chemical properties to cocaine (smile) and is not well absorbed from the nasal mucosa. According to studies, less than 1% of the administered dose is absorbed from the nose.
Part of the dose of beclometasone is absorbed from the gastro-intestinal tract. No systemic side effects should occur because the dose is very low and also because beclometasone is rapidly metabolised and cleared from the body.
Posted by zzzz7 on May 16, 2010, at 4:51:16
In reply to Re: Prednisone and Immediate AD Response » bulldog2, posted by SLS on April 27, 2010, at 15:53:01
As some of you know, I went from taking very high doses of SSRIs (e.g. 110mg Prozac+100mg modafinil daily) to being unable to take more than .1mg Prozac. At roughly the same time I developed reactive hypoglycemia and exercise-induced depression.
I'm now looking at adrenal fatigue as a factor here. I've learned a lot from people here; thank you. After 18 months of hardcore depression, I'm making real progress on 3mg of mirtazapine daily. I'm hoping that addressing adrenal issues will bring me the rest of the way through.
One issue I have is that I'm able to keep the reactive hypoglycemia at bay only if I run, but if I run I get much more depressed (I'm just shot for 5-6 hours after I run).
If I figure anything out, I'll let the board know. But for the few others here who had similar reactions to SSRIs, you might give low-dose mirtazapine a shot. (At low doses it's mainly blocking serotonin.)
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