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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by Tenifer on August 31, 2005, at 14:34:16
A case of HPA Axis dysregulation?
First let me say thank you to everyone for sharing your experiences and trials with everyone. I know I speak for many others who are being helped by everyone's insightful thoughts and research. I everyone else who visits and posts here the very best.
I'm posting to see if anyone has any idea what happened to me? Maybe someone can suggest a treatment protocol for my doctor. I am considering a visit to an endocrinologist soon. First, let me give you some history.
I've had what I call a low-grade anxiety for several years as my world became more stressful and demanding. I would feel the anxiety coursing through my system but it wouldn't interfere with my sleep or performance. It always abated late in the evening and whenever I left whatever stressor I was dealing with behind.
I drank a ton of Pepsi (caffeine) daily and rarely drank water. I had other somatic problems too like stomach pain and difficulty swallowing, all examined and proven benign and attributed to anxiety and stress.
I had mentioned my anxiety to my GP in the past and he offered me Lexapro but I declined because it wasn't that big of a problem for me, although in work it had been steadily growing in severity.
It was mostly bad at work and when under high stress situations at home but it was manageable. What I mean by manageable is that it always went away and I could always sleep 9-10 hours if I wanted too and even took naps. Nevertheless, it was persistent stress, both at work and home, and that set the stage.
I never really knew how t respond to stress. When I would run into a problem in work I would stay engaged until I discovered a solution. Yes, I would feel the pressure build in me but I wouldn't pull back. Pretty bad response to stress I'd say.
Anyway, a few months before my problem I got trapped in a locked vestibule at work and couldn't escape. The building was empty and they had changed the combination on the door without letting me know the new combo. Thats when I experienced my first panic attack. I managed to calm myself down enough to find a way out of the confining space. I had never had anything like that happen to me before. In fact, it surprised me and I even laughed and joked about it with my coworkers. This was in March of 2004, I believe.
At the end of May of 2004 I contracted a pretty bad case of poison ivy while clearing out some weeds in my yard. It got on my face and it seemed to be getting worse so I (mistakenly) saw my GP (I should have just toughed it out). He prescribed Medrol (prednisone) to alleviate the rash and itching. It was a six-day dose pack and I completed it on schedule. I had no problems while I was taking it.
Two days after stopping the Medrol, after tapering as dosed, I had what I can only call an "insanity attack." I literally felt as if my mind were tearing itself to pieces! I would have been relieved to have been hit by lightning during those first days after stopping. Death would have been my deliverer. It seemed endless. I got a chance to see what hell is like. I wouldn't wish it on the most evil person on the world.
It was only through God's grace that I survived the initial insanity and slowly, saw my symptoms improve but I still had persistently high anxiety that I would rate as being just shy of having a constant panic attack, just to give you an idea. That lasted about a week. I couldn't eat, sleep or function. I was being pumped full of adrenalin non-stop and nothing could shut it off.
By the end of the week I thought I could go out - it was the weekend so my wife and I went to a local mall. After I got there I found myself despondent and emotionally spent and just collapsed on the ground in despair and exhaustion. My wife got me to eat a soft pretzel (I hadn't been able to eat anything up to that point) and a short time later, much to my surprise, I experienced a tremendous improvement in my symptoms.
The following 2 weeks were pretty weird. I had become basically anxiety free but I had been very tired during the day. I even had to come home from work early one day just to take a nap. The only other thing I was suffering was a kind of "balloon head" feeling. Like I was lightheaded and not "in phase" if that makes any sense. Maybe it was vertigo but who knows. But it was tolerable and I thought it would go away in time. I was very glad to be sleeping well again and for the anxiety to have gone away.
Then it all came to an end. Monday morning, in work, I had another anxiety attack and I was done. It felt like the return of the insanity attack and I quickly made an appointment with my GP. He prescribed Paxil CR 12.5mg and Xanax.
Big mistake. My extremely agitated and stressed nervous system couldn't handle the early activation phase of the SSRI's. After 1 week of nightly panic attacks (never had them before) and 2-3 hours sleep a night I called my GP. he said "you have to double up" so I started taking 25mg Paxil CR. Well, you can guess what happened next. I got MUCH worse.
I went back to the Paxil 12.5mg dose and slowly things improved but I was still very anxious during the day and couldn't sleep. I started seeing a Psychiatrist and he offered me Desyrel to help with the sleep. It worked wonders and allowed me to keep taking the Paxil for a few months although I still couldn't titrate the dose up. Interestingly, I would get what I call a "calm period" that started around 8pm and last throughout the evening. Has anyone else experienced this? I wonder what the mechanism for this effect is?
Anyway, my PDoc and I decided to try augmenting with Buspar. As before, I could only tolerate the lowest dose and I didn't see any further improvement from it. When I tried to increase the dose I experienced intense anxiety and psychic distress (I don't know what else to call it).
We then tried Effexor with the same inability to titrate up and even worse anxiety and worst of all, I lost my "calm period" which I looked forward to as a chance to recharge my batteries, so to speak.
We decided to come off of everything and get back to baseline. I had some withdrawal problems but they abated after a couple of weeks. I was feeling much better then when I was on the meds but I still had the dang anxiety haunting me and my sleep was very poor.
Anyway, let me fast forward here in case anyone is actually reading this far. I decided to try 5-HTP to help with sleep (working with a MD who is also a naturopath) and that didn't work out too well. We raised the dose pretty fast to over 500mg a day and all it did was make my anxiety worse and give me paresthesia in my arms and head.
I pretty much started to give up the goal of avoiding addiction to Ambien, Xanax, etc. but I had to sleep. I could handle the daytime anxiety if I could just sleep. After reading many website I decided to give St. John's Wort a try (Metagenics brand). It saved my life. Within a week I started sleeping better and had less anxiety. I eventually settled on 1125mg but even then I still had uncomfortable anxiety but it was at a level that I told myself I could live with.
Stressful events have been particularly significant since I had this problem. Great coincidences, huh? My mother was diagnosed with cancer and had surgery (She's 73), both of my dogs had to be euthanized, my father had to be put into a nursing home due to a stroke and subsequently fell and broke his hip. Sadly, I don't expect him to last much longer. My wife started premature menopause, and there's more but I won't bore you. There just aren't that many bright spots in my life right now.
Needless to say these stressors have impacted the efficacy of the SJW. My biggest stressor now, in addition to worrying about my prognosis, is a debacle of a home improvement project that needs addressing. So the SJW isn't really doing the trick at this dose anymore and this unrelenting anxiety is really starting to get me into a depressed mood. I've been dealing with this for 15 months now.
I know that this is a very long story and I am truly grateful to anyone who has bothered to read this far. I hope that someone can help elucidate me here.
What the heck did the Medrol do to me? I thought it suppresses HPA function?
Did it somehow upregulate my HPA Axis after i stopped taking it?
This Medrol effect thing has be really stumped. If I knew what it did I might be able to figure what therapy would be best to reverse this condition.I've had 3 serum cortisol tests done last year (when I was on the Paxil) and noticed it increased with each test but it was still within norms. Thyroid tests came back "normal" also. I've just had another blood draw to check for cortisol and dhea, testosterone, etc. but the results aren't back yet. So I'm at a loss.
I really don't want take any psychiatric meds in light of my problems with the ones I've tied. And I'm very afraid of the addictive potential of benzos and sleeping pills so I try to avoid them as much as possible. I guess I need some guidance on what I should do now.
I take all sorts of supplements and amino acids. I've just started taking L-Tryptophan under the guidance of my doctor but its only been 2 days. I'm considering raising the SJW until I get this house thing settled then going back down.
I don't know. I've read so much but am more confused as ever.
I hope someone can help me get my bearings...
My gut instinct is that this is endocrinology-based (in light of the Medrol and the 2-week interval of relative normalcy) but I don't know what to do to address it or determine if thats the case.
Thank you again for the help!
Any and all suggestions or comments would be most welcomed by this weary traveler...David
Please feel free to email me if you want. I can chat via Yahoo Messenger too if you prefer.
Posted by Tenifer on August 31, 2005, at 16:41:58
In reply to A case of HPA Axis dysregulation? (long), posted by Tenifer on August 31, 2005, at 14:34:16
sorry it was so long-winded :( <nm>
Posted by lunesta on August 31, 2005, at 19:58:32
In reply to A case of HPA Axis dysregulation? (long), posted by Tenifer on August 31, 2005, at 14:34:16
I can tell you that I have heard of similar stories of people going on and then off prednisone and having phsycosis and other major anxiety problems. I dont know why, something with the immune system i believe. Prednisone suppresses the immune system.
I dont know the solution in your case but if this is greatly impacting your life quality, you may want to consider just going on the addicting med route and go for Klonopin for anxiety/panic/sleep. It works wonders, but you may be on it forever.
The 8:00 thing is explainable yes. Your endorphins and adenosine levels rise between 8pm and 9pm to initiate the natural sleep cycle. When these rise, it slows down your brain, slowing glutamate (which can be toxic) and calcium flow into the cells. This may be the peace you feel, i know the feeling as well.
It sounds like you might have a case of excitotoxcity - your brain's inhibition system isnt working correctly OR you have to much glutamate and calcium firing in your neurons etc..
This is common in nearly ever "mental" disorder. It just manifests differently. Have you tried natural things such as L-theanine? You might want to try Neurontin, its not as addicting at all as benzos and is great for mood stabalizing sleep etc.. It happens to be a calcium channel blocker and glutamate blocker at the spinal level.
You might want to look into a calcium channel blocker in general such as nimodipine (nimotop). Excellent for glutamate/calcium overload.
Lexapro is generally the best SSRI if you want to go that route.
Desipramine is unique in that i regrows the brain area involved in stress. Its an old trcyclic but works great.
You might want to try magnesium suklphate injections, and increase magnesium in your diet or supplements, magnesium is the natural blocker of NMDA/glutamate/excitotoxicity/calcium overload. People who are mag defeienct have panic attacks and hyperventilate. Check all your eltrolytes actually. Especially potassium and magnesium.
You might also want to try a ketogenic diet or calorie restricted diet as this naturally increases the expression of GAD65 and 67 the rate limiting enzymes for GABA synthesis.
Remeron might help a bit with the HPA axis problems and sleep problems.
lunesta
Posted by Tenifer on September 1, 2005, at 11:38:37
In reply to A case of HPA Axis dysregulation? (long), posted by Tenifer on August 31, 2005, at 14:34:16
Hi Lunesta, thanks for reading my rather lengthy post and for putting together such a detailed response. You have given me a lot of information that i wasn't aware of.
I've taken Klonopin and yes, it does help but it is quite sedating. But, as you are everyone else knows, its addictive. I really don't want to compound my problem by sowing the seeds for a bigger headache down the road. In fact, thats the fear that keeps me from trying different meds. Withdrawal from these drugs is something that I dread and drug company coverups and deceptions don't give me any great confidence in their safety over the long term.
I've found L-Theanine (Suntheanine) to be okay but it is rather mild. I've taken 400mg at a time but maybe I should try more. As for the Neurontin, my psychiatrist says he gets some pretty good results using it and that some of his patients even get off benzos by switching to Neurontin. I just need more information on the withdrawal effects of this agent before i will be comfortable trying it (if I can ever be comfortable trying a pharmaceutical agent).
As far as Lexapro goes, given my poor performance with Paxil and Effexor I'm not sure that the SSRI class of meds will work out for me. I think that, should I decide to explore the antidepressant route again, that my next stop would be the TCA because of their long history and better understood long-term effects.
I didn't know that desipramine regrows brain areas involved in stress. Would you (or anyone) have any references or links to abstracts available on this? I will be certain to ask my PDoc about this at our next meeting.
The Remeron actually seems like a good fit but I'm afraid to try anything that messes with my HPA Axis function given that the Medrol (prednisone) completely fouled that up on me.
And yes, I am currently supplementing with a chelated Magnesium Glycinate to the point that I am giving myself diarrhea but I plan to stick with it, especially if I go on a TCA since this effect may help with the side effect of constipation.
The information on the ketogenic diet is something else I had not heard before. That will be the subject of some research (probably when I finish this post). Thank you for adding to my knowledgebase. :)
At the present I have raised my dose of St. John's Wort to 1350mg day and have started taking L-Tryptophan supplements (500mg in morning and 500mg before bed). I'll see how that goes for a while. I really want to exhaust every non-pharmaceutical therapy I can before returning to the synthetics. I'm also doing CBT and am actively (and sometimes dramatically) doing away with chronic stressors that have been bothering me for years. Hopefully all of these approaches will synergize to get me back to where I was before ingesting that poisonous creation.
Thanks again for the helpful post Lunesta. I wasn't sure anyone would bother what with my long post and all. I am indebted to you. :)
Posted by denise1966 on September 5, 2005, at 4:39:16
In reply to A case of HPA Axis dysregulation? (long), posted by Tenifer on August 31, 2005, at 14:34:16
Hi Tenifer,
I read your story and a lot of your symptoms sounded like mine. I was suffering like this for around two years, the light headedness, the constant feeling of anxiety etc regardless of what was going on around me and the slight release in the evenings. The one drug which was a god-send and I just took it as and when needed was Zyprexa 10mg. It really helped when I got to the point where I just couldn't go on anymore and after taking it felt more motivated, rational and clear headed for at least 7 days after taking it.
I'm not advocating you use it but it can really help if you take it at about 7pm you'll find you'll sleep better, eat better the next day and hopefully feel a lot better. It might just give you that respite you need.
Zyprexa is an antipsychotic drug and as far as I know it is not addictive.
Thing is some people complain it makes them feel very flat but I never found this to be the case if I just take it now and again.
Kind Regards.....Denise
Posted by Tenifer on September 6, 2005, at 12:26:56
In reply to Re: A case of HPA Axis dysregulation? (long), posted by denise1966 on September 5, 2005, at 4:39:16
Hi Denise,
Thanks for taking the time to read my post and
reply. I'm going to save it for future
reference so I can explore that possibility
should the need arise.But today I'm in a pit. My father passed away
last night with my sister and I at his side.
Its a tough ride now so I'm just holding fast
to my belief in Jesus and going forward.The Lord answered my prayers last night: He
took my father gently, He gave us all a chance
to thank my father and reconcile our regrets
before he passed and most of all, he hage me a
chance to pray with my dad before he left us.I'm crying as I write this but I'm comforted
in the knowledge that God responded to all of my
prayers last night and that, among them, was
the prayer that the Lord accept my father into
His kingdom. I'm certain that my dad is with
Jesus now and free of the suffering that plagued
his last 2 years here on earth.I thank the Lord for the gift of being present
at my father's passing and for the promise of
eternal life with Jesus to those who believe,
repent and ask forgiveness of the Father through
His Son, Jesus Christ.May God bless each of you this day and forever
more...David
This is the end of the thread.
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