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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by SLS on February 1, 2006, at 19:25:33
Has anyone tried this?
Metyrapone is a cortisol synthesis inhibitor with a mechanism of action different from ketoconazole. Currently, it is used in the U.S. only as a test for HPA axis abnormalities. However, it has been tested for depression and has shown positive results as an adjunct to standard antidepressants.
- Scott
Posted by Phillipa on February 1, 2006, at 20:25:26
In reply to Metyrapone - Has anyone tried this?, posted by SLS on February 1, 2006, at 19:25:33
Scott I hope you find some relief soon you have suffered so much and so long. Fondly, Phillipa
Posted by 4WD on February 1, 2006, at 23:05:55
In reply to Metyrapone - Has anyone tried this?, posted by SLS on February 1, 2006, at 19:25:33
> Has anyone tried this?
>
> Metyrapone is a cortisol synthesis inhibitor with a mechanism of action different from ketoconazole. Currently, it is used in the U.S. only as a test for HPA axis abnormalities. However, it has been tested for depression and has shown positive results as an adjunct to standard antidepressants.
>
>
> - ScottScott,
When I had my ACTH dexamethasone suppression test (where I had to take dexamethasone for 3 days and then go in and have an injection and then have my cortisol levels checked every 15 minutes) I don't know what drug they used in the injection to. It may have been the drug you were talking about. I do know that about an hour after the injection I felt horrible. Then about two hours after that I felt great and continued to feel great for the next day or two.
it probably has nothing to do with what you are talking about but I thought I'd throw it out there just in case.Marsha
Posted by blueberry on February 2, 2006, at 5:22:05
In reply to Metyrapone - Has anyone tried this?, posted by SLS on February 1, 2006, at 19:25:33
I'm puzzled by the prospect of inhibiting cortisol synthesis. The reason is that cortisol is frequently way low in people with mood disorders. Elevated cortisol levels are rare. All this according to my doctor anyway, who specializes in combining psychiatric meds and nutrional support strategies.
Cortisol is indeed elevated early in the disease or condition. But that is short lived. The adrenal glands become exhausted, give up, and then cortisol levels drop off the charts and are unable to recover on their own. That's how it was explained to me anyway.
Low cortisol or inappropriate ratios of cortisol to dhea often explain things when meds don't work well, or have amplified side effects, or produce paradoxical or quirky results. According to my doctor. I have no personal opinions on it.
I'm an amateur when it comes to hormones, but from most things I have read and from what my doctor sees in her practice, nearly all psych patients need cortisol support, not cortisol inhibition.
So I am puzzled.
Posted by SLS on February 2, 2006, at 7:48:39
In reply to Re: Metyrapone - Has anyone tried this?, posted by blueberry on February 2, 2006, at 5:22:05
Do the adrenal glands become exhausted in Cushings disease?
To the best of my knowledge, it is still generally accepted that hypercortisolemia is one of the most consistent biological findings in melancholic, psychotic, and bipolar depression whereas atypical depression often involves hypocortisolemia. It might be a function of severity of depression and the presence of anxiety.
These are the sort of findings that attracted me to trying antiglucocorticoid therapies.
Just for the hell of it, I tried taking dexamethasone for four days to see if it might not reduce the tone of the HPA axis. It didn't seem to ameliorate my depression.
Perhaps HPA activation is a state-specific condition that is the result of, and not the cause of, depression. Or perhaps it plays some role in the perpetuation of depression, leaving some people treatment-resistant to standard antidepressant therapies.
- Scott
Posted by blueberry on February 3, 2006, at 5:21:10
In reply to Re: Metyrapone - Has anyone tried this? » blueberry, posted by SLS on February 2, 2006, at 7:48:39
Hi Scott,
Have you had cortisol and dhea levels checked? If not, check out idealhealth.com. This mailorder lab has a 4 sample saliva test that gives your results in numerical form and graph form and compares to normal ranges. It also shows what stage the adrenal glands are in, with 6 stages ranging from normal to adrenal failure. Extremely useful, easy, and inexpensive test. I was very happy with this lab. Not happy with my cortisol and adrenals though...adrenals almost completely shut down and cortisol is a million miles below the normal range at all 4 sample times of the day.
I don't know much about Cushings disease or cortisol. All I know is what my doctor has told me, and that is that when cortisol levels are out of whack, or when adrenal glands are overstressed or failing (shown by the ratio relationship between dhea and cortisol provided in graph form by the idealhealth.com lab), that no amount of meds are going to work right. She says getting the cortisol and adrenals in the normal range can really wake up the meds and the catecholamines and turn the lights on.
Knowing the meds that you are on and the minimal help they are providing you, it did occur to me the possibility of adrenal and/or thyroid hypofunction. Especially when my doc said that no amount of meds are going to work right. She wonders why all practioners do not start with adrenal function first, since everything else revolves around that. She admits that practitioners are not trained in it.
Idealhealth has other useful tests as well, including one that results in a customized vitamin/mineral formula compounded specifically for your body depending on your test results. Also an allergy test. But I think the stress test (cortisol/dhea) is the most useful.
Posted by SLS on February 3, 2006, at 7:17:21
In reply to Re: Metyrapone - Has anyone tried this? » SLS, posted by blueberry on February 3, 2006, at 5:21:10
Thanks Blueberry.
I had taken a cortisol test before starting the mifepristone. For some reason, my doctor hadn't received the results or misplaced them. I guess I should go to the lab and pick up a copy for myself. I probably would have done that already if I could just get myself to give damn. I am feeling very defeated right now.
Has your depression been characterized as following an atypical pattern?
(Mood-reactivity, increased appetite or weight gain, oversleeping or spending more time in bed, severe fatigue creating a sensation of leaden paralysis or extreme heaviness of arms or legs, and adulthood rejection sensitivity. Social anxiety might be a symptom associated with atypical depression as well).
If so, your low levels of cortisol are consistent with what has been reported by some investigators regarding this subtype.
Could you explain where DHEA fits into the equation? I haven't researched it much.
Thanks.
- Scott
Posted by Iansf on February 3, 2006, at 19:10:02
In reply to Re: Metyrapone - Has anyone tried this? » SLS, posted by blueberry on February 3, 2006, at 5:21:10
I looked at the idealhealth.com site, and it's not clear what results they provide with the stress test. Do they provide the actual measurements, or do they just recommend which supplements to take without letting you know the numerical results?
By the way, there are numerous Internet sites providing home health tests - including TSH, testosterone, estrogen, psa and cortisol measurement and certain components of a standard blood panel. The prices also vary - a lot. I have no idea how accurate these tests are, but I've seen no outcry claiming they're bogus.
> Hi Scott,
>
> Have you had cortisol and dhea levels checked? If not, check out idealhealth.com. This mailorder lab has a 4 sample saliva test that gives your results in numerical form and graph form and compares to normal ranges. It also shows what stage the adrenal glands are in, with 6 stages ranging from normal to adrenal failure. Extremely useful, easy, and inexpensive test. I was very happy with this lab. Not happy with my cortisol and adrenals though...adrenals almost completely shut down and cortisol is a million miles below the normal range at all 4 sample times of the day.
>
> I don't know much about Cushings disease or cortisol. All I know is what my doctor has told me, and that is that when cortisol levels are out of whack, or when adrenal glands are overstressed or failing (shown by the ratio relationship between dhea and cortisol provided in graph form by the idealhealth.com lab), that no amount of meds are going to work right. She says getting the cortisol and adrenals in the normal range can really wake up the meds and the catecholamines and turn the lights on.
>
> Knowing the meds that you are on and the minimal help they are providing you, it did occur to me the possibility of adrenal and/or thyroid hypofunction. Especially when my doc said that no amount of meds are going to work right. She wonders why all practioners do not start with adrenal function first, since everything else revolves around that. She admits that practitioners are not trained in it.
>
> Idealhealth has other useful tests as well, including one that results in a customized vitamin/mineral formula compounded specifically for your body depending on your test results. Also an allergy test. But I think the stress test (cortisol/dhea) is the most useful.
Posted by blueberry on February 3, 2006, at 20:13:29
In reply to Re: Metyrapone - Has anyone tried this?, posted by Iansf on February 3, 2006, at 19:10:02
I have had the Privatest (custom vitamin urine test), the allergy test (blood test), and the stress test (4 sample saliva test) from idealhealth. They do a great job. The results of the stress test are in both numerical and graph form, and they also make recommendations on how to correct imbalances.
There are other sites that test thyroid and sex hormones and such. A lot of them appear to me to be affiliates, not the main lab. I'm sure they are legit though. The problem though is that depending on what State you live in, laws may or may not allow you to order tests by yourself without a doctor's order.
Anyway, I like idealhealth a lot. They have helped me to learn more about what's going on in my body than 10 years of doctors ever did.
Posted by blueberry on February 3, 2006, at 20:33:27
In reply to Re: Metyrapone - Has anyone tried this? » blueberry, posted by SLS on February 3, 2006, at 7:17:21
Hi Scott,
Based on the desciptions you provided on atypical depression, I do not think that fits me very well.
I think the reason my cortisol is so low is because I have been under physical and emotional stress for so long. Completely due to my depression, not outside stressors. Cortisol being low is one thing, but what it means I think is more important...that is, the adrenals aren't working...norepinephrine and dopamine are falling asleep at the wheel, regardless of how much is floating around.
But back to your original question of the thread, there are simple ways to both raise and lower cortisol levels and to re-energize sluggish adrenal glands. Even without tests, you could try going in both directions and see which direction seems more promising.
I am not well versed on the dhea/cortisol interplay. One can be up, the other down, or they can both be up or both down. The relationship I think is useful in showing what stage of normalcy or exhaustion the adrenal glands are in.
Posted by 4WD on February 3, 2006, at 21:44:14
In reply to Re: Metyrapone - Has anyone tried this? » Iansf, posted by blueberry on February 3, 2006, at 20:13:29
> I have had the Privatest (custom vitamin urine test), the allergy test (blood test), and the stress test (4 sample saliva test) from idealhealth. They do a great job. The results of the stress test are in both numerical and graph form, and they also make recommendations on how to correct imbalances.
>
> There are other sites that test thyroid and sex hormones and such. A lot of them appear to me to be affiliates, not the main lab. I'm sure they are legit though. The problem though is that depending on what State you live in, laws may or may not allow you to order tests by yourself without a doctor's order.
>
> Anyway, I like idealhealth a lot. They have helped me to learn more about what's going on in my body than 10 years of doctors ever did.Blueberry,
What did you actually do with the results of the stress test? I mean did you go to your doctor and say, see what I found out? Did the doctor take you seriously or think it was quackery?
I've been to two endocrinologists and they never suggested the saliva testing. I am wondering whether if I found something was amiss (by taking this test) whether doctors would heed it. I had several 24 hour urinary tests and some bloodwork for cortisol and metanephrines and stuff and it all came back normal except for extremely high cortisol.
I guess I'm asking whether taking this test - the stress test- actually had a practical result. Were you able to take steps as a result of the info you got from the test that resulted in correcting or improving your depression/anxiety?
And were their recommendations mostly geared toward buying their supplements or were they more broad ranging?
Marsha
Posted by blueberry on February 4, 2006, at 5:41:32
In reply to Re: Metyrapone - Has anyone tried this? » blueberry, posted by 4WD on February 3, 2006, at 21:44:14
Hi Marsha,
It was actually my doctor's idea and not my own to take these tests. As for quackery, yeah, I think most doctors would think it is. That's mainly because they aren't trained in it. My doctor has 10 years of experience with this stuff in treating the whole body instead of just the brain symptoms because her goal is to make medications work better, to work at lower doses, and to even eliminate them altogether with some patients.
I'm sure there is a component in the stress test where they want you to buy their supplements. There is no sales pitch or prodding though. They provide good information up front on what the ingredients are and what they do and how to dose them. They also make all the other usual recommendations such as relaxation techniques, diet, and exercise. They also suggest speaking to your healthcare practitioner about how to correct things. I think their supplements are too limited though. They are designed to support good adrenal function, but if we need quick cortisol or dhea adjustments, they probably won't do that.
My doctor does not want to begin treatment until after I have had a sex hormone test next week. She wants some baseline readings. I believe she is headed in the direction of over the counter adrenal cortex supplements, or pregnenalone, or dhea, or licorice root. No surprise, all of these have known antidepressant qualities if used and dosed properly. She also liked the way I responded to a 3 day sample of dl-phenylalanine, so she is already encouraging me to continue taking it once every two to three days (its endorphin boosting qualities keep endorphin levels raised for several days after a single dose).
In your case, lowering cortisol is easy and fast with Seriphos (phosphorylated serine).
I have experienced an improvement in my depression and anxiety, and I can't believe it but it is mostly from the custom vitamin from idealhealth that they made based on my urine test. Long story, too many details, but the vitamins and minerals in it are in different forms than what we can buy over the counter. Since I've taken high dose vitamins and minerals for years with no effect, I was stunned to feel this vitamin actually make a difference. Improvement began 3 days after starting it. I asked myself if this was a placebo effect. But I'm sure it isn't.
Anyway, sorry to ramble. I think the bottom line is that, in my limited knowledge, the adrenal glands seem to be the engine that drives the catecholamines norepinephrine and dopamine. If they are overamped, there are psychiatric problems. If they are sluggish, there are psychiatric problems. And in either case, medications cannot work to their fullest potential or don't work at all.
So sorry Scott, I didn't mean to get off topic from Metyrapone. :-(
Posted by 4WD on February 4, 2006, at 21:56:11
In reply to Re: Metyrapone - Has anyone tried this? » 4WD, posted by blueberry on February 4, 2006, at 5:41:32
Thanks, Blueberry, I think I'll order the stress test. It makes so much sense. I believe my adrenals are overamped and that would explain why taking adrenal supplements made me worse.
I'll stop now, not to take this thread further off track. But I wish I had a doctor like yours (I mean a general health care practioner, my pdoc is great).
Marsha
Posted by 4WD on February 4, 2006, at 21:57:44
In reply to Re: Metyrapone - Has anyone tried this? » 4WD, posted by blueberry on February 4, 2006, at 5:41:32
P.S.
I have a bunch of high quality adrenal supplements from my acupuncturist which were obviously not a good idea for me with my high cortisol levels. Babblemail me if you'd like them.
Marsha
Posted by jerrympls on February 6, 2006, at 22:36:53
In reply to Metyrapone - Has anyone tried this?, posted by SLS on February 1, 2006, at 19:25:33
> Has anyone tried this?
>
> Metyrapone is a cortisol synthesis inhibitor with a mechanism of action different from ketoconazole. Currently, it is used in the U.S. only as a test for HPA axis abnormalities. However, it has been tested for depression and has shown positive results as an adjunct to standard antidepressants.
>
>
> - ScottMy doct was going to try me on this - however, the company that makes it wouldn't allow it. They said they only give it out in special cases - for ON LABLE uses.
SUCKS!!!!
This is the end of the thread.
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