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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by katekite on June 5, 2002, at 20:58:59
So when are the corticotrophin releasing factor antagonist drugs coming out?
What other drugs inhibit cortisol production or release with the fewest side effects?
I just got my 24hr urine cortisol test back -- got 46 with normal being 2-34. Doc says normal for someone my age is around 10. Also was not badly stressed the day of the test or even within a week or so before, was off all my ADD drugs etc. My GP is going for a CT of my abdomen and referral to an endocrinologist, but I'm secretly worried this is just me and no cause -- I have very few cushenoid signs: I'm relatively skinny and not particularly hairy. And I know depressed people can have high cortisol... of course I'm not too depressed lately, but who knows. I thought high cortisol was only seen with really serious depression like with psychosis, or in elderly people with major depression -- does anyone know?
So what's everyone's take on cortisol and the chicken and egg thing with anxiety and depression. Definitely high cortisol is supposed to make you feel depressed -- isn't it odd I don't feel worse?
Have other people had cortisol checked and how high were they?
If no cause is found do I go on antidepressants to lower it despite not being clinically depressed and my history of ADs not actually working?
kate
Posted by Iago Camboa on June 6, 2002, at 5:34:11
In reply to high cortisol, posted by katekite on June 5, 2002, at 20:58:59
Hi Kate,
This may not be a great help but the only easy to get drug who is believed to diminish cortisol levels is the anti-aging medicine Gerovital-H3 (basically procaine), which is also a (mild) reversible MAOI with AD properties.
Take care.
Iago
Posted by johnj on June 6, 2002, at 9:17:12
In reply to high cortisol, posted by katekite on June 5, 2002, at 20:58:59
Hi,
Here is some info that fachad listed on the trimipramine thread above. It is worth the read, but may not be exactly what you are looking for.
johnj
Trimipramine: a challenge to current concepts on antidepressives.Berger M, Gastpar M.
Klinikum, Albert-Ludwigs-Universitat, Freiburg, Germany.
Although it is chemically a classical tricyclic antidepressant agent, trimipramine shows atypical pharmacological properties. Its well-documented antidepressant action cannot be explained by noradrenaline or serotonin reuptake inhibition or by a down-regulation of beta-adrenoceptors. Furthermore, its receptor affinity profile resembles more that of clozapine, a neuroleptic drug, than that of tricyclic antidepressants. Trimipramine does not reduce, but rather increases, rapid eye movement sleep. It stimulates nocturnal prolactin secretion and inhibits nocturnal cortisol secretion and may act at the level of the hypothalamus on corticotropin-releasing hormone secretion. Trimipramine is of particular value in depressed patients with insomnia, and it has been shown to be effective in the therapy of primary insomnia. As the pharmacological profile indicates, and an open clinical study has shown, trimipramine might also be active as an antipsychotic. The drug is both a tool for increasing our understanding of depression and a potential therapy for several psychiatric disorders.
Depression 1996;4(1):1-13 Related Articles, Books, LinkOut
Trimipramine and imipramine exert different effects on the sleep EEG and on nocturnal hormone secretion during treatment of major depression.Sonntag A, Rothe B, Guldner J, Yassouridis A, Holsboer F, Steiger A.
Max Planck Institute of Psychiatry, Department of Psychiatry, Munich, Germany.
In a 4-week double-blind clinical trial we compared the effects of the tricyclic antidepressants trimipramine and imipramine on the sleep EEG and on nocturnal bormone secretion in 20 male inpatients with major depression. Both treatments produced rapid significant clinical improvement in depression without severe adverse effects. However, the two drugs had markedly different neurobiologic profiles. Trimipramine enhanced rapid eye movement (REM) sleep and slow wave sleep, whereas imipramine suppressed REM sleep and showed no effect on slow wave sleep. Total sleep time and the sleep efficiency index increased under trimipramine but not under imipramine. Nocturnal cortisol secretion decreased with trimipramine but remained unchanged with imipramine. In contrast to imipramine, trimipramine induced an increase in prolactin secretion compatible with its known antagonism at dopamine (D2) receptors. Imipramine induced a decrease in growth hormone secretion during the first half of the night. Neither of the drugs induced significant changes in plasma testosterone concentration. We conclude that trimipramine is an antidepressant with sleep-improving qualities that possibly acts through inhibition of hypothalamic-pituitary-adrenocortical system activity by a yet unknown mechanism.
Posted by Ritch on June 6, 2002, at 10:05:39
In reply to high cortisol, posted by katekite on June 5, 2002, at 20:58:59
Posted by Chloe on June 7, 2002, at 22:30:39
In reply to Re: high cortisol (katekite), posted by johnj on June 6, 2002, at 9:17:12
> Hi,
>
> Here is some info that fachad listed on the trimipramine thread above. It is worth the read, but may not be exactly what you are looking for.
> johnj
>
>
> Trimipramine: a challenge to current concepts on antidepressives.
>
> Berger M, Gastpar M.
>
> Klinikum, Albert-Ludwigs-Universitat, Freiburg, Germany.
>
> Although it is chemically a classical tricyclic antidepressant agent, trimipramine shows atypical pharmacological properties. Its well-documented antidepressant action cannot be explained by noradrenaline or serotonin reuptake inhibition or by a down-regulation of beta-adrenoceptors. Furthermore, its receptor affinity profile resembles more that of clozapine, a neuroleptic drug, than that of tricyclic antidepressants. Trimipramine does not reduce, but rather increases, rapid eye movement sleep. It stimulates nocturnal prolactin secretion and inhibits nocturnal cortisol secretion and may act at the level of the hypothalamus on corticotropin-releasing hormone secretion. Trimipramine is of particular value in depressed patients with insomnia, and it has been shown to be effective in the therapy of primary insomnia. As the pharmacological profile indicates, and an open clinical study has shown, trimipramine might also be active as an antipsychotic. The drug is both a tool for increasing our understanding of depression and a potential therapy for several psychiatric disorders.
>
>
> Depression 1996;4(1):1-13 Related Articles, Books, LinkOut
>
>
> Trimipramine and imipramine exert different effects on the sleep EEG and on nocturnal hormone secretion during treatment of major depression.
>
> Sonntag A, Rothe B, Guldner J, Yassouridis A, Holsboer F, Steiger A.
>
> Max Planck Institute of Psychiatry, Department of Psychiatry, Munich, Germany.
>
> In a 4-week double-blind clinical trial we compared the effects of the tricyclic antidepressants trimipramine and imipramine on the sleep EEG and on nocturnal bormone secretion in 20 male inpatients with major depression. Both treatments produced rapid significant clinical improvement in depression without severe adverse effects. However, the two drugs had markedly different neurobiologic profiles. Trimipramine enhanced rapid eye movement (REM) sleep and slow wave sleep, whereas imipramine suppressed REM sleep and showed no effect on slow wave sleep. Total sleep time and the sleep efficiency index increased under trimipramine but not under imipramine. Nocturnal cortisol secretion decreased with trimipramine but remained unchanged with imipramine. In contrast to imipramine, trimipramine induced an increase in prolactin secretion compatible with its known antagonism at dopamine (D2) receptors. Imipramine induced a decrease in growth hormone secretion during the first half of the night. Neither of the drugs induced significant changes in plasma testosterone concentration. We conclude that trimipramine is an antidepressant with sleep-improving qualities that possibly acts through inhibition of hypothalamic-pituitary-adrenocortical system activity by a yet unknown mechanism.Jon,
Thanks for posting this info. My pdoc just switched my from amitriptyline to trimip tonight. Gee, I am really looking forward to it's benefits. In theory sounds like a winner for me. But we will see how I feel in the morning! and the next and the next.Thanks again :)
Chloe
Posted by johnj on June 8, 2002, at 1:28:16
In reply to Re: high cortisol » johnj, posted by Chloe on June 7, 2002, at 22:30:39
Chloe,
Please keep me informed on how it goes. I am going to inquire about adding and maybe changing to trimp. when I go on my next visit. I don't want to keep upping my dose of my benzo when I can't sleep. Who knows maybe trimp will allow me to work out again without feeling like dirt. Good luck and I hope it works for you. Check out the trimp thread above if you haven't already. Peace.
Johnj
Posted by katekite on June 8, 2002, at 10:49:15
In reply to Re: high (Chloe), posted by johnj on June 8, 2002, at 1:28:16
Thanks.
That was a very good point about having it retested. I have a neurology appointment june 20 and a endocrinology appt july 1 so one of them hopefully will figure it out. And a abdominal CT scan for next thursday.
I think it's really interesting if my psychological issues were related to high cortisol.
Talking to my pdoc thurs, he said they used to routinely test inpatients (late 70s) for high cortisol as some very small percentage ended up having cushing's syndrome. They eventually stopped doing it because 1. the percentage was small, and 2. the tests were not that good. The interesting thing is now these days they have much better tests that are apparently able to differentiate high cortisol as a result of mental illness, from mental illness as a result of high cortisol. Both occur. The tests are basically blood and urine tests, they are cumbersome but not very invasive. My pdoc says he thinks my cortisol is too high to be explained by mental illness. But I am not going to be sure until that's backed up with a few tests.
I will post back with what happens. It could be someone else out there has a similar scenario.
One of the things I find interesting is just how robust a response I had to neurontin. I felt 5-10 years younger on it. It makes me wonder if it affects cortisol -- but pubmed lists no research published relating gabapentin to cortisol. Either there is none (unlikely) or there's no good impressive result. Probably a bit premature to start wondering if med responses can indirectly indicate a suspicion for high cortisol.
If it does turn out high cortisol that was curable all along caused my recent psychiatric problems, you can bet I will be on a mission to prevent others from having to go through that.
Thanks for your responses and input.
kate
Posted by Chloe on June 8, 2002, at 17:45:53
In reply to Re: high (Chloe), posted by johnj on June 8, 2002, at 1:28:16
> Chloe,
>
> Please keep me informed on how it goes. I am going to inquire about adding and maybe changing to trimp. when I go on my next visit. I don't want to keep upping my dose of my benzo when I can't sleep. Who knows maybe trimp will allow me to work out again without feeling like dirt. Good luck and I hope it works for you. Check out the trimp thread above if you haven't already. Peace.
> JohnjJohn,
Oops, I got you confused with JonW. If you check the thread about trimip. I just posted my first night's experience. I forgot to mention in the post that I halved my benzo dose this am. Just didn't want it or need it. So this stuff may prove useful. Have you ever tried a TCA for sleep before? I find them quite helpful. Better than benzos.Take care,
Chloe
Posted by johnj on June 8, 2002, at 18:30:30
In reply to Re: high (Chloe) » johnj, posted by Chloe on June 8, 2002, at 17:45:53
HI Chloe:
Thanks for posting your experiences with trimp. I have been on 50 mg of nortryptline for 9 years or so. But, the thing I don't like is that it seems to hose up my moods when I excercise. I have found a few more people with that same experience and it has come to the point I can't work-out without paying for it a few days later and taking many days to resolve itself.I am looking for something to give me better rest than I feel from nortryptline. It has been a decent med, but nothing spectacular. I had to increase my benzo lately since my sleep has been giving me fits. That is why I am looking at trimp. I tried a little imipramine since I heard that it doesn't mess up sleep after excercise, but if I increase my TCA side effects nail me big time. I did get the sweats and a little jittery from imipramine too, but I have a feeling it might pass if I stick it out, which I am not willing to do right now. So, I am intrigued by the benzo cutting you had after taking the trimp. To me, that is a good sign. It appears that trimp helps with anxiety issues, of which I have big time. And if I can find something that helps my sleep and get somewhat stabilized I will try working out again. I hope that feeling was only from the nortryp. Let us know and I encourage you to look at the above thread where fachad lists the studies done on trimp. It may explain the dreams you had. It sounds like a good drug for restoring sleep. Take care. Johnj
Posted by Chloe on June 9, 2002, at 20:10:56
In reply to TCA's (Chloe), posted by johnj on June 8, 2002, at 18:30:30
Hi John,
What do you mean by "hose up" your moods when you exercise? Do you get depressed after you workout? Or is it a cardiac thing r/t the TCA?I guess I am getting an education in TCA's. I kinda thought all TCA's were similar in action and side effects. I thought I was swapping a sedating TCA (amitriptyline) for another (trimipramine). But I am finding I am having increased anxiety, cardiac palps and racing, and insomnia of all things! Be sure to read the post above about my 2nd night. I had to add benzo to get any sleep last night. But I am not sure most people react this way to trimip. Alot of folks seem to take it for insomnia and anxiety. So, YMMV, and I hope trimip. prove helpful to you, so you can exercise again.
Take care,
Chloe
Posted by johnj on June 9, 2002, at 22:03:17
In reply to Re:TCA's » johnj, posted by Chloe on June 9, 2002, at 20:10:56
HI Chloe,
Sorry to hear about the rough night for you. Did you just switched the amit for trimp? Could there be some rebound from changing so abrubtly? My biggest problem right now is how to switch from notry to trimp. I don't think a direct switch will work. My pdoc wanted me to work my way up with imipramine to a theraputic level and then go down, but the problem was I had side effects and some jitterness that spooked me so I dropped the imipramine test. I will discuss trimp in a week.
What I mean by "hosed up" is that when I step up a workout to make it somewhat meaningful I get an overall rotten feeling that starts with sleep problems, depression, enhanced side effects like a return to past dry mouth and especially dizziness. Doc says it is not the med, but I have found people that had the same problem on amitryptline which is the parent drug of nortry; however, they didn't have the problem on imipramine. So, the TCA's are not all equal like the ssri's are not equal. Excercise is my way to help myself which is very depressing when I cannot. This odd effect after working out usually came about after a certain period of time, but recently, probably due to being in my 30's, it has started to happen more quickly. I take lithium and some benzo, but have not heard from anyone that these have caused this feeling. Last fall I was into my 4th week of jogging again and started to feel like crap. It took over 2 weeks to work itself out. I had started a new job 6 weeks earlier so I thought that might also be a reason for some troubles again. So, I waited a month or so and tried lifting and after a few weeks felt like crap again. Sorry to ramble, but that is the readers digest version my TCA experience.
I am interested in trimp for the sleep aspect. I might have to give up excercise until something better comes along. I am not very interested in ssri's since they may cause some panic attacks and I want to avoid anything that may cause anxiety and panic with depression. Again, check with your doc about switching the meds slowly. I am not sure the best way, but cold turkey might have some withdraw effects that have nothing to do with the trimp. Hope all goes well and you get some sleep. Hang in there we are all in this together.
Peace
Johnj
Posted by Chloe on June 10, 2002, at 21:04:11
In reply to Re:TCA's(Chloe), posted by johnj on June 9, 2002, at 22:03:17
> HI Chloe,
>
> Sorry to hear about the rough night for you. Did you just switched the amit for trimp? Could there be some rebound from changing so abrubtly? My biggest problem right now is how to switch from notry to trimp. I don't think a direct switch will work. My pdoc wanted me to work my way up with imipramine to a theraputic level and then go down, but the problem was I had side effects and some jitterness that spooked me so I dropped the imipramine test. I will discuss trimp in a week.
>
> What I mean by "hosed up" is that when I step up a workout to make it somewhat meaningful I get an overall rotten feeling that starts with sleep problems, depression, enhanced side effects like a return to past dry mouth and especially dizziness. Doc says it is not the med, but I have found people that had the same problem on amitryptline which is the parent drug of nortry; however, they didn't have the problem on imipramine. So, the TCA's are not all equal like the ssri's are not equal. Excercise is my way to help myself which is very depressing when I cannot. This odd effect after working out usually came about after a certain period of time, but recently, probably due to being in my 30's, it has started to happen more quickly. I take lithium and some benzo, but have not heard from anyone that these have caused this feeling. Last fall I was into my 4th week of jogging again and started to feel like crap. It took over 2 weeks to work itself out. I had started a new job 6 weeks earlier so I thought that might also be a reason for some troubles again. So, I waited a month or so and tried lifting and after a few weeks felt like crap again. Sorry to ramble, but that is the readers digest version my TCA experience.
>
> I am interested in trimp for the sleep aspect. I might have to give up excercise until something better comes along. I am not very interested in ssri's since they may cause some panic attacks and I want to avoid anything that may cause anxiety and panic with depression. Again, check with your doc about switching the meds slowly. I am not sure the best way, but cold turkey might have some withdraw effects that have nothing to do with the trimp. Hope all goes well and you get some sleep. Hang in there we are all in this together.
> Peace
> JohnjWell,
I am sorry you are having difficulty with TCA's and exercise. What you describe is really the pits. And it must be hard that you pdoc doesn't think it's the med. I think problems like you outlined should be taken seriously. And exercise is so essential to feeling well and being healthy and fit.Are you drinking enough water? I know that sound silly, but with the Li and Nort. I think you must get dry as a bone when you sweat. You must have to drink at least an extra gallon when you are working out. I know I need soooo much water, esp. since I added amitrip 20 mgs. It's amazing how much water I can drink, and I don't pee that much. FWIW. You might try flooding yourself before, during and after workouts, see if it makes a difference?
I don't recommend swapping one med for another, unless they are truly "sister" drugs. Make sure you have a plan established with your pdoc if you do plan to transition to trimip. Because for me, dropping out Amitrip 20 mgs, and taking trimip 25 mgs in it's place really messed me up. I had chills and sweats, heart palps, and insomnia, restlessness, stomach problems. And I also think I have some exacerbation of my TD in my mouth. (Trimip does touch on dopamine, so if you have any TD issues, this is a TCA I would avoid.) But who knows what was withdrawal and what is just the side effects of a new TCA? All the things I mentioned are listed in the adverse reactions of all the TCA's, trimip and ami included. I am waiting to hear from my pdoc about what I should "do" about trimip. I d/c'd it last night. I was so scared to take it again and NOT sleep and feel so agitated, and possible have my tongue movements increase. Taking the smallest amount of ami 10 mgs settled me, and I slept so well :)
Well, I think I am rambling. My body is still reeling from this. Feel kinda yucky. Keep me/us posted on what happens next for you! Do you think your pdoc will go for a trial of Trimi? Is he a fan of this drug? My pdoc seems to be, I wish I know why....
Chloe
Posted by johnj on June 11, 2002, at 13:01:17
In reply to Re:TCA's » johnj, posted by Chloe on June 10, 2002, at 21:04:11
Hi Chloe,
Yes, I have tried flooding myself and I do drink a lot of water everyday. But, even a short 15 minute jog screws me up and I havent' really lost much H20 with such a short workout. I know somebody that has experienced what I have and they have been on amitry. which is the mother drug of norty. But, this could be just a freakish thing for a minority of people. Do you have any problems with excercise? I don't think it is the lithium for me, but one never knows for sure. I am just going to get stable all around and then try something new in the fall or next spring. I might even try lifting lightly and see if I can get away with that.
I would like to try trimp since the improved sleeping patterns it helps with are very attractive. I will have to wait until Monday to see what the doc says. But, there is no telling if it would allow me to work out any better either. I tried to switch to imip. but it made me jittery, kind of what you describe when you went to trimp. I do know my doc wants to get me on a good dose of another AD then taper the other. But, with TCA's the side effects kill me. Night sweating has been a recent problem so not sure what that means. Let me know how things go. Take care
johnj
Posted by Chloe on June 11, 2002, at 20:44:20
In reply to Re:TCA's(chloe), posted by johnj on June 11, 2002, at 13:01:17
> Hi Chloe,
>
> Yes, I have tried flooding myself and I do drink a lot of water everyday. But, even a short 15 minute jog screws me up and I havent' really lost much H20 with such a short workout. I know somebody that has experienced what I have and they have been on amitry. which is the mother drug of norty. But, this could be just a freakish thing for a minority of people. Do you have any problems with excercise? I don't think it is the lithium for me, but one never knows for sure. I am just going to get stable all around and then try something new in the fall or next spring. I might even try lifting lightly and see if I can get away with that.
> I would like to try trimp since the improved sleeping patterns it helps with are very attractive. I will have to wait until Monday to see what the doc says. But, there is no telling if it would allow me to work out any better either. I tried to switch to imip. but it made me jittery, kind of what you describe when you went to trimp. I do know my doc wants to get me on a good dose of another AD then taper the other. But, with TCA's the side effects kill me. Night sweating has been a recent problem so not sure what that means. Let me know how things go. Take care
> johnjJohn,
Fachad wrote a wonderful comparison of 3 TCA's in the above thread. Very informative. I would not rule out trimip if you taper properly. I think most of my troubles were withdrawal related. I wish I could give trimip another try, but I can't related to the DAntagonism. I hope you at least talk about it with your pdoc. Changing meds is hell, but staying on meds that limit your activity or lifestyle or happiness is hell too.Let us know how it goes with the pdoc. Hang in there.
Chloe
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