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Dr. Bob is Robert Hsiung, MD,
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Posted by farshad on March 16, 2018, at 10:31:51
In reply to Re: How can I block Cortisol?, posted by farshad on March 16, 2018, at 10:31:02
> so people with anxiety shouldnt take SSRI?
> people with cancer shouldnt take anti biotics or whatever it is they take?
>
> Why cant I take cortisol antagonists? and why cant you atleast help me out and explain to me so I can understand it better and which drug would suit me the best? If I didnt have anxiety for such a long time as I have almost 10 year I wouldnt give the SNPS a second thought at all. But I do have anxiety and it its so bad I cant ignore it.SNPs is what I used to and it says I have cortisol mutations which causes excess.
Posted by ed_uk2010 on March 16, 2018, at 10:52:50
In reply to Re: How can I block Cortisol? » ed_uk2010, posted by farshad on March 16, 2018, at 8:53:47
Hi,
Unless you have elevated cortisol levels as demonstrated by an endocrine specialist, you would not want to take any anti-cortisol medication. You could end up absolutely exhausted and very sick, and may potentially collapse. Cortisol is a hormone which is necessary for life. Without it, we would be dead.
Although some people with mental health problems have disruption of the HPA axis, you would not use these drugs in psychiatry unless it was part of a clinical trial with specialist blood monitoring. The HPA axis should normalise when the mental health condition is treated with a psych medication, or psychological therapy.
About the meds you asked about:>Spironolactone - this drug has a wide array of hormonal effects, such as blocking testosterone and aldosterone. It is not used in any mental health condition. It is useful in chronic heart failure, ascites of liver disease and occasionally in combination with estrogens as part of a male to female sex change.
>Mifepristone - This abortion drug is supplied to specialist clinics only. Any other use would need to be part of a clinical trial.
>Metyrapone - it would be very dangerous to take this drug without specialist monitoring. It could lead to a dangerous drop in cortisol levels.
>Ketoconazole and miconazole - when taken by mouth, these drugs can cause liver damage. Ketoconazole tablets have been discontinued in most countries.
Posted by ed_uk2010 on March 16, 2018, at 11:10:56
In reply to Re: How can I block Cortisol?, posted by farshad on March 16, 2018, at 10:31:02
Hi,
>Why cant I take cortisol antagonists?
If you have seen an endocrinologist and they determine that this is necessary, you can. But you wouldn't use these drugs otherwise.
None of the meds you asked about are treatments for anxiety. You'd only use anti-cortisol drugs for a severe cortisol excess under specialist monitoring.
Cortisol release is essential for the body's response to stress. Blocking cortisol from being released can cause you to collapse when you're under stress.
>why cant you at least help me out and explain to me so I can understand it better and which drug would suit me the best?
I'm trying. But you can't decide to take an anti-cortisol drug because you have anxiety. Anti-cortisol drugs are only prescribed if specialist blood tests and sometimes scans show that they are a suitable treatment option.
Usually, anti-cortisol drugs are used for Cushing's syndrome.
Posted by farshad on March 16, 2018, at 11:43:07
In reply to Re: How can I block Cortisol?, posted by ed_uk2010 on March 16, 2018, at 10:52:50
> Hi,
>
> Unless you have elevated cortisol levels as demonstrated by an endocrine specialist, you would not want to take any anti-cortisol medication. You could end up absolutely exhausted and very sick, and may potentially collapse. Cortisol is a hormone which is necessary for life. Without it, we would be dead.
>
> Although some people with mental health problems have disruption of the HPA axis, you would not use these drugs in psychiatry unless it was part of a clinical trial with specialist blood monitoring. The HPA axis should normalise when the mental health condition is treated with a psych medication, or psychological therapy.
>
>
> About the meds you asked about:
>
> >Spironolactone - this drug has a wide array of hormonal effects, such as blocking testosterone and aldosterone. It is not used in any mental health condition. It is useful in chronic heart failure, ascites of liver disease and occasionally in combination with estrogens as part of a male to female sex change.
>
> >Mifepristone - This abortion drug is supplied to specialist clinics only. Any other use would need to be part of a clinical trial.
>
> >Metyrapone - it would be very dangerous to take this drug without specialist monitoring. It could lead to a dangerous drop in cortisol levels.
>
> >Ketoconazole and miconazole - when taken by mouth, these drugs can cause liver damage. Ketoconazole tablets have been discontinued in most countries.
Ok so Say theoretically I had high cortisol which would be the best option? Metyrapone ? any other med u know of?
I will talk to my doctor but I just wanna see what drugs I should bring up incase I do have high cortisol.
Posted by baseball55 on March 16, 2018, at 17:14:19
In reply to Re: How can I block Cortisol?, posted by farshad on March 16, 2018, at 11:43:07
> Ok so Say theoretically I had high cortisol which would be the best option? Metyrapone ? any other med u know of?
> I will talk to my doctor but I just wanna see what drugs I should bring up incase I do have high cortisol.
>
> If you indeed have high cortisol (do you have any symptoms of Cushings?), you would be referred to an endocrinologist. This is not a situation that a primary care physician would treat. Specialists in Cushings know what drugs to use and you'd best discuss the options with them. I have a good friend with Cushings and went to several appointments with her to help her remember what happened and sort through her options. I doubt you and people on this list are more knowledgable about Cushings than a specialist would be. AND, nobody is going to prescribe anti-cortisol drugs without testing for excess cortisol, a process that takes numerous 48-hour urine and saliva tests. (This is because cortisol rises and falls constantly, so measuring it at one point in time doesn't tell you anything.)
>
Posted by Phillipa on March 16, 2018, at 17:45:05
In reply to Re: How can I block Cortisol?, posted by baseball55 on March 16, 2018, at 17:14:19
True so very true Phillipa
Posted by ed_uk2010 on March 16, 2018, at 17:54:35
In reply to Re: How can I block Cortisol?, posted by farshad on March 16, 2018, at 11:43:07
>Ok so Say theoretically I had high cortisol which would be the best option?
Cortisol levels vary greatly throughout the day and according to circumstances. A one off 'high' blood cortisol doesn't suggest anything unless it is very severely elevated. You would not be prescribed any medication based on a one off reading.
To demonstrate that cortisol is consistently and abnormally high, you would have several tests. These may include:
A careful physical examination for signs of elevated cortisol,
a 24 hour urine collection and analysis for cortisol content (this test is often done twice),
a late night saliva test for cortisol concentration,
and an overnight dexamethasone suppression test with morning analysis of blood cortisol level.
If tests demonstrated that you had an abnormally high level of cortisol, the first step would be to investigate the cause. Scans may be done to look for tumors on the adrenal glands (CT abdomen), or the pituitary (MRI head). Cortisol excess caused by tumors are sometimes treated with surgery. Medication is generally used when the condition is inoperable.
Cortisol levels may be slightly elevated in people experiencing stress, and in people with certain mental health problems. This is treated by dealing with the mental health problem, not by blocking cortisol.
>I just wanna see what drugs I should bring up in case I do have high cortisol.
A psychiatrist or general practitioner wouldn't use anti-cortisol drugs. They are only used by endocrine specialists.
Posted by farshad on March 16, 2018, at 18:07:15
In reply to Re: How can I block Cortisol? » farshad, posted by ed_uk2010 on March 16, 2018, at 17:54:35
> >Ok so Say theoretically I had high cortisol which would be the best option?
>
> Cortisol levels vary greatly throughout the day and according to circumstances. A one off 'high' blood cortisol doesn't suggest anything unless it is very severely elevated. You would not be prescribed any medication based on a one off reading.
>
> To demonstrate that cortisol is consistently and abnormally high, you would have several tests. These may include:
>
> A careful physical examination for signs of elevated cortisol,
>
> a 24 hour urine collection and analysis for cortisol content (this test is often done twice),
>
> a late night saliva test for cortisol concentration,
>
> and an overnight dexamethasone suppression test with morning analysis of blood cortisol level.
>
> If tests demonstrated that you had an abnormally high level of cortisol, the first step would be to investigate the cause. Scans may be done to look for tumors on the adrenal glands (CT abdomen), or the pituitary (MRI head). Cortisol excess caused by tumors are sometimes treated with surgery. Medication is generally used when the condition is inoperable.
>
> Cortisol levels may be slightly elevated in people experiencing stress, and in people with certain mental health problems. This is treated by dealing with the mental health problem, not by blocking cortisol.
>
> >I just wanna see what drugs I should bring up in case I do have high cortisol.
>
> A psychiatrist or general practitioner wouldn't use anti-cortisol drugs. They are only used by endocrine specialists.
>
>
>ok but still didnt answear my question,answered everything but my question.
Posted by Phillipa on March 16, 2018, at 18:18:50
In reply to Re: How can I block Cortisol?, posted by farshad on March 16, 2018, at 18:07:15
Ask for a referral to an endocrinologist who can perform the tests listed. And then base treatment on his/her findings. There is no one best or not best med. If due to anxiety then a psych doctor can prescribe meds to decrease your anxiety levels. Best of luck to you. Phillipa
Posted by PeterMartin on March 16, 2018, at 19:26:17
In reply to Re: How can I block Cortisol?, posted by farshad on March 16, 2018, at 18:07:15
> ok but still didnt answear my question,answered everything but my question.Wikipedia, library, or https://scholar.google.com
Please.
Thank you.
Answered.
Posted by ed_uk2010 on March 17, 2018, at 10:35:57
In reply to Re: How can I block Cortisol?, posted by farshad on March 16, 2018, at 18:07:15
>ok but still didnt answear my question,answered everything but my question.
Sorry, but that is because your question does not have an answer. You wouldn't need to suggest an anti-cortisol drug to a specialist endocrinologist. If one was needed, they would make the selection.
Unless you are seeing an endocrinologist, it would not be worth suggesting any of these drugs - they are not used in psychiatry.
Posted by ed_uk2010 on March 17, 2018, at 12:15:47
In reply to How can I block Cortisol?, posted by farshad on March 16, 2018, at 7:42:29
>I wanna decrease CRF1 activity.
About your question. The drugs you listed aren't CRF-1 antagonists, if that helps. Blocking cortisol receptors or inhibiting its synthesis would not have the same effect as a CRF-1 antagonist. That is important.
Taking a CRF-1 antagonist for depression/anxiety might be possible as part of a clinical trial. But they aren't otherwise available.
I'm really not sure what you're trying to treat, to be honest. Could you give more details about your history and symptoms? I think people could offer much better advice if they knew more about you. Even leading neuroscientists only have a limited knowledge of how neurotransmitters work, so it's not possible to accurately predict medication response on this basis. Only to a vague extent.
In general, psychiatry isn't particularly scientific. Not enough is understood. Medication is generally tried based on symptom clusters and likely response because there is usually no alternative method.
So, what meds are you taking right now and how are you doing?
Posted by farshad on March 17, 2018, at 12:39:49
In reply to Re: How can I block Cortisol? » farshad, posted by ed_uk2010 on March 17, 2018, at 12:15:47
> >I wanna decrease CRF1 activity.
>
> About your question. The drugs you listed aren't CRF-1 antagonists, if that helps. Blocking cortisol receptors or inhibiting its synthesis would not have the same effect as a CRF-1 antagonist. That is important.
>
> Taking a CRF-1 antagonist for depression/anxiety might be possible as part of a clinical trial. But they aren't otherwise available.
>
> I'm really not sure what you're trying to treat, to be honest. Could you give more details about your history and symptoms? I think people could offer much better advice if they knew more about you. Even leading neuroscientists only have a limited knowledge of how neurotransmitters work, so it's not possible to accurately predict medication response on this basis. Only to a vague extent.
>
> In general, psychiatry isn't particularly scientific. Not enough is understood. Medication is generally tried based on symptom clusters and likely response because there is usually no alternative method.
>
> So, what meds are you taking right now and how are you doing?
>
>
>
>Im taking some dopamine meds helps with depression and stuff not much for my social anxiety.
But these cortisol blockers I listed why wouldnt they help for an Overactive CRF1? Since they decrease cortisol which would lead to less cortisol circeling around and that would lead to CRF1 downregulation ?
I dont think I have cushings syndrome or tumours or whatever . I think I just have some mutations in my CRF1 making it overactive, here are some weird SNPs I got that I cant find any info about on the internet:
1. It says I have a mutation in my CRHR1
2. It says I have something called CRHR1-IT1 (CRHR1 intronic transcript 1) mutation (cant find anything about this)
all the info I could find about it :
Protein names
Recommended name:Putative uncharacterized protein encoded by CRHR1-IT1
Alternative name(s):CRHR1 intronic transcript 1
3. It says I have MGC57346-CRHR1 2.35 (this 1 cant find anything on either)
So you know thats a couple of mutations in my CRF1 . So my main Problem seems like a problem with the CRF1 .
So thats why I think I have too much cortisol due to CRF1 and my CRF1 has lead to an overactive ACTH.. So I dont know what to do. There is a drug called antalarmin but I dont know how to get it. there also a drug called Astressin-B which is sold in a hair product which I can get Over the counter it supposedly blocks CRH (so CRF1 and CRF2 included). that I wanna try. But im afraid it not might work since its topical and I heard it doesent cross the BBB..
Posted by ed_uk2010 on March 17, 2018, at 14:11:31
In reply to Re: How can I block Cortisol?, posted by farshad on March 17, 2018, at 12:39:49
Hi,
So, you've had some genetic tests, maybe something online? Who did the tests?
>But these cortisol blockers I listed why wouldnt they help for an Overactive CRF1? Since they decrease cortisol which would lead to less cortisol circulating around and that would lead to CRF1 downregulation?
If you took a drug which decreased cortisol, your cortisol levels would most likely drop below normal levels. Your body would then try to overcome this in order to bring cortisol levels back to normal. CRF may be upregulated to try and do this. Your body would not downregulate CRF in response to low cortisol, because that would cause your cortisol to become even lower. The body always tries to achieve hormonal balance (homeostasis).>I think I just have some mutations in my CRF1 making it overactive, here are some weird SNPs I got that I cant find any info about on the internet.
If you're concerned about this, you could be tested for high cortisol. I mentioned the tests in my previous post. Doctors usually test for high cortisol if a patient has signs that it is high, for example:
Loss of fat in the arms and legs, plus an increase in fat at the back of the neck, chest, and abdomen.
A round puffy face, usually reddish.
Development of large purple stretch marks on the body.
Skin has started to bruise easily.
>There is a drug called....I get where you're coming from, but you are getting way ahead of yourself :) If you think you might have high cortisol due to the tests you've had so far, you would need to be tested properly for high cortisol before taking any drugs. Otherwise, it would not be safe. Look at the symptoms above and if you have them, a doctor may do a test for high cortisol.
Now IF your cortisol levels were proven to be elevated, and the elevation was sustained and pronounced, a doctor might prescribe something for this after further investigation.
Posted by ed_uk2010 on March 17, 2018, at 14:19:19
In reply to Re: How can I block Cortisol?, posted by farshad on March 16, 2018, at 18:07:15
>answered everything but my question...
OK now your turn. I'm trying to answer your questions, so you should tell me :) ... What symptoms and problems are you hoping to treat by working on the HPA axis (CRF, ACTH, cortisol etc)?
I'm not asking about genetic tests or theories about neurotransmitters. I want to know, what do you feel is wrong with your mental health, that you want to make better?
Posted by Phillipa on March 17, 2018, at 17:44:25
In reply to Re: How can I block Cortisol?, posted by farshad on March 17, 2018, at 12:39:49
Hi, F, can I as really an observer ask a question? If so. And you say you have anxiety. What have you taken so far for it? Benzodizapines, atypical antipsychotics? Or Depression meds? I'm sure I'm a much older person than you are also. I will be 72 female on Tuesday and have been through periods of time where when thyroid was diagnosed by endocrinologist as Hasimotos thyroiditis that my anxiety was so high that I took per MD instructions quite high doses of benzos and nothing touched it? Since a female this was when going through Menopause. Then it basically calmed down so today although still do take benzos per Psychiatrist I take extremly low doses. Oh I'm from the USA. What country do you reside it? Thanks Phillipa
Posted by farshad on March 17, 2018, at 21:08:13
In reply to Re: How can I block Cortisol? » farshad, posted by Phillipa on March 17, 2018, at 17:44:25
thanks for all the help. Im gonna be using Metyrapone to block cortisol production.
Posted by Lamdage22 on March 18, 2018, at 5:50:21
In reply to Re: How can I block Cortisol? » farshad, posted by Phillipa on March 17, 2018, at 17:44:25
<I'm sure I'm a much older person than you are also.
I also think so. Its ok to make mistakes as long as they dont harm you. Good luck with that.
Posted by ed_uk2010 on March 18, 2018, at 6:49:10
In reply to Re: How can I block Cortisol?, posted by farshad on March 17, 2018, at 21:08:13
>Im gonna be using Metyrapone to block cortisol production.
Obtained from where? Online? I assume so.
I'm really confused about what you're trying to achieve. Cortisol is an essential hormone like insulin. It isn't something you would just casually want to block. Detailed tests would be needed.
Posted by farshad on March 18, 2018, at 10:43:00
In reply to Re: How can I block Cortisol? » farshad, posted by ed_uk2010 on March 18, 2018, at 6:49:10
> >Im gonna be using Metyrapone to block cortisol production.
>
> Obtained from where? Online? I assume so.
>
> I'm really confused about what you're trying to achieve. Cortisol is an essential hormone like insulin. It isn't something you would just casually want to block. Detailed tests would be needed.
>
yeah im gonna be getting it from my doctor after ive done cortisol testing.
Posted by Phillipa on March 18, 2018, at 11:33:03
In reply to Re: How can I block Cortisol?, posted by farshad on March 18, 2018, at 10:43:00
So glad to hear you are seeing a doctor to test you. Will it be an endrocrinologist? Phillipa
Posted by ed_uk on March 18, 2018, at 11:52:01
In reply to Re: How can I block Cortisol?, posted by farshad on March 18, 2018, at 10:43:00
>yeah im gonna be getting it from my doctor after ive done cortisol testing.
Surely that depends totally on the results of the tests, no? :)
Metyrapone is not readily available in all countries. So the choice of drugs is also location dependent.
Posted by farshad on March 18, 2018, at 11:56:42
In reply to Re: How can I block Cortisol? » farshad, posted by ed_uk on March 18, 2018, at 11:52:01
> >yeah im gonna be getting it from my doctor after ive done cortisol testing.
>
> Surely that depends totally on the results of the tests, no? :)
>
> Metyrapone is not readily available in all countries. So the choice of drugs is also location dependent.Of course it depends on the results, But im saying if it turns out I do have high cortisol problems I will ask for Metyrapone. and I checked Metyrapone exists in Sweden.
All these exist to where I live (sweden):
Mifepristone
Flucanazole
Miconazole
Ketoconazole
Spironolactone
MitotaneBut I think Metyrapone would be the best choice. Do you know about other drugs that block cortisol that maybe I can bring up with my doctor incase I do have high cortisol that might be better option?
Posted by ed_uk2010 on March 18, 2018, at 12:55:58
In reply to Re: How can I block Cortisol?, posted by farshad on March 18, 2018, at 11:56:42
>But I think Metyrapone would be the best choice.
Metyrapone has a lot of side effects, it's only for Cushing's Syndrome.
If you have mild cortisol elevations associated with depression and anxiety, you might want to look at mirtazapine. It is one of the antidepressants which may help to reduce high cortisol in depressed pts.
Posted by farshad on March 18, 2018, at 13:03:46
In reply to Re: How can I block Cortisol? » farshad, posted by ed_uk2010 on March 18, 2018, at 12:55:58
> >But I think Metyrapone would be the best choice.
>
> Metyrapone has a lot of side effects, it's only for Cushing's Syndrome.
>
> If you have mild cortisol elevations associated with depression and anxiety, you might want to look at mirtazapine. It is one of the antidepressants which may help to reduce high cortisol in depressed pts.well if you look at the other cortisol drugs ive listed their side effects are a lot worse.
I tried mirtazapine already didnt work. Where did you see the side effecs for Metyrapone ? I dont see any listed on wikipedia.
Metyrapone has been found in early human trials to reduce recollection of emotional memories in normal volunteers. The volunteers showed significant impairment in ability to retrieve memories with negative emotional content while not impairing memories with neutral content. This has significant implication in the study of the process of emotional healing in post traumatic stress disorder.[2][3]
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