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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by nuala on September 24, 2008, at 10:14:25
I am/or have been made hypoadrenal from Seroquel. It is complicated by a hypothyroid condition.
I recently tried a trial of hydrocrotisone 20+ mg/day, multi-dosing for 6 weeks.
I am now in the midst of a bad glucocorticoid withdrawal and need to go back on an SSRI to temporarily correct my suppressed HPA axis and adrenal function.
Which SSRI is best to counteract this situation.
I have acute anxiety due to this situation - lots of physcial symptoms too - dizzy, nauseous, shaky. Bad!
I am still stuck on 12.5 mg Seroquel which is certainly exacerbating it.
I need to get the hpa axis up, and cortisol up, but not over-stimulate myself. (yes, I have had plenty of tests showing partial secondary adrenal insufficieny)
Dr suggested Luvox. I have some Lexapro, I considered taking, bur don't know what is best to do.
Thanks
Posted by Phillipa on September 24, 2008, at 11:05:10
In reply to Best SSRI for post-steroid HPA axis suppression?, posted by nuala on September 24, 2008, at 10:14:25
Does this mean you have Addison's disease? Did you have addrenal fatique first? Luvox for a correction of adrenals this is new to me any links about it? Thanks Phillipa
Posted by nuala on September 24, 2008, at 11:14:55
In reply to Re: Best SSRI for post-steroid HPA axis suppression? » nuala, posted by Phillipa on September 24, 2008, at 11:05:10
I have some degree of adrenal insufficiency.
I embarked on a course of steroids to correct it.
I had great instability on the multi-dosing and had ups and downs - anxiety, depression, strange thoughts. So, I had to stop.
Now, I am six weeks post hydrocortisone treatment, and am in the midst of a steroid withdrawal syndrome.
My HPA axis is suppressed, my adrenals are suppressed.
The Seroquel I take down-regulatres the HPA axis further and decreases cortisol. Even the 12.5 mg I am on is having a great impact.
A pdoc suggestd elevating the HPA axis by means of an SSRI.
Some SSRIs have this effect. I have read elsewhere in endocrinological articles that using an SSRI such as Lexpro can be helpful.
He reccommened Luvox. I started at 25mg, but it was not a good experience by day 3 - palpiations, extreme over stimulation, etc etc.
I used to be on Lexapro and seemed to tolerate it well. thinking of going back.
Wanted to know if anyone has any suggestions re the types of SSRIs and their effectiveness at elevating the HPA axis and raising cortisol.
Posted by Phillipa on September 24, 2008, at 15:35:19
In reply to Re: Best SSRI for post-steroid HPA axis suppressio, posted by nuala on September 24, 2008, at 11:14:55
So seroquel lowered your cortisol levels? Love Phillipa
Posted by Roslynn on September 24, 2008, at 15:35:52
In reply to Re: Best SSRI for post-steroid HPA axis suppressio, posted by nuala on September 24, 2008, at 11:14:55
Hi,
I don't have any answers (sorry) but just wanted to post that I too am splitting the seroquel tabs to 12.5 (sometimes less, they tend to break) and I am having a horrible time getting off this drug. Spent most of day crying today. It is miserable.
I hope you get some good answers from the board, there are a lot of smart folks here. Hang in thereRoslynn
Posted by Nuala on September 24, 2008, at 15:51:08
In reply to Re: Best SSRI for post-steroid HPA axis suppressio, posted by Roslynn on September 24, 2008, at 15:35:52
I have been working on it since July. I had to go back to a higher dose a few times. Going down from 25 mg. I had been stable on that for a year and a half. I was, however, on thyroid meds at the time and felt A LOT better. I remained stable, but never really good. But, better than being drugged up all day and feeling every morning like I had been out late drinking the night before.
I have been disolving the 25 mg in a 10 ml dropper, like a kiddie medicine dropper with 10 ml gradations. I shaking it well as I go along to keep it mixed and squirt a few ml at a time into my mouth.
That way, I can go down with more precision than just cutting. Nothing is perfectly exact, but I use the other half of the 50mg tab for the next night, that way, at least I attempt to keep the bllod level even.
Good luck with it.
PS Why are you cutting back?
Posted by Nuala on September 24, 2008, at 16:00:20
In reply to Re: Best SSRI for post-steroid HPA axis suppressio » nuala, posted by Phillipa on September 24, 2008, at 15:35:19
Yes, even low doses significantly decrease ACTH and cortisol.
This is an interesting article
The atypical antipsychotics olanzapine and quetiapine, but not haloperidol, reduce ACTH and cortisol secretion in healthy subjectsYou can get the whole article if you click for the pdf.
www.springerlink.com/content/701865l57115k063I likely never should have been put on the Seroqeul to begin with, as I had hypothyroidism untreated for many years, and likely concomitant adrenal issues.
Now, with the suppression of my HPA axis and adrenals following the steroids, the effects of
the Seroquel are really bad.You see, some people (according to what I have read in the literature) who do well on antipsychotics of this type, are those who seem to have a hyperactivity of the HPA axis and/or elevated cortisol. I think the newest atypical antipsychotics are designed with this effect in mind.
I did some reasearch and found that a large majority of antipsychotics have this effect, some have an equivocal effect, and I only found one so far that actually raises cortisol...Fluphenazine.
But, I think the same can be accomplished with an SSRI. I worry though, that I read that prolonged use of an SSRI, can cease to have an elevating effect on the HPA axis and sometimes tired ones adrenals. But I am not sure there is agreement on that point, at least I have not read it as yet.
Posted by bleauberry on September 24, 2008, at 17:04:39
In reply to Best SSRI for post-steroid HPA axis suppression?, posted by nuala on September 24, 2008, at 10:14:25
Lexapro. While antidepressant effects on cortisol are not well studied, there are a few showing Lexapro stimulates cortisol. Many others do the opposite. Remeron calms down an overexcited axis, with a slight bebound later, while Reboxetine totally evens it out and keeps it that way. I found Milnacipran was good for that, since I have extreme peaks and valleys in cortisol over 24 hours. These things all have something in common...they work on norepinephrine. So why lexapro, I don't know. Just going by what I saw at pubmed.
I don't know why you stopped HC. It is usually needed for a year to get things under control. Six weeks is way too short, unless you couldn't tolerate it for some reason. Some people need it for life. We have no idea how these powerhorse antipsychotics mess things up or not.
Though slow and gradual, the proper eating strategy can help adrenals a lot. No caffeine, no or very low sugar, mostly proteins and low-sugar veggies, low carbs, only low-sugar fruits (berries), lots of clean purified water. Basically heavy on chicken, beef, eggs, and veggies.
You may already know, but licorice is good for hypoadrenalism because it slows down the breakdown process of what cortisol you have. You cortisol lasts longer and goes farther. While there are many internet claims and chinese folklore of adrenal herbs, looking in pubmed shows two in particular, in combination, balanced adrenals regardless if they were low or high...siberian ginseng+astragulus. You can also use adrenal cortex extract (not the whole adrenal extract), with or without the licorice or herbs.
Cutting someone off of 20mg HC without a long slow taper is insane. I can't believe that is being done to you. It is not only extremely uncomfortable, it is extremely dangerous and even life threatening.
Not sure why the finger is pointed at seroquel. Could certainly be the culprit. But also, the stress that caused you to take seroquel in the first place could be the guilty one. Or mercury/lead toxicity. Nothing in my knowledge screws up adrenals+thyroid more often than those two metals. They come from unlikely hidden sources that would surprise you, and even tiny amounts can cause severe disruptions for genetically weak people.
Adrenals and thyroid work in harmony. Treat one without the other and it can make you feel worse. Armour thyroid is preferred by many hypothyroid folks. Sometimes there is too much T4-to-reverseT3 conversion, which would mean you need pure T3.
There are good Yahoo forums on all this stuff.
Posted by nuala on September 24, 2008, at 17:30:09
In reply to Re: Best SSRI for post-steroid HPA axis suppression?, posted by bleauberry on September 24, 2008, at 17:04:39
I had to stop the HC since I was unable to tolerate it. I had heart palps and "surges" of something for a period after the each dose, then a trough of low cortisol WAY before next dosing time. It was unbearable to suffer through.
In combo with the Seroqeul, at night after taking the Seroquel, I would have a low cortisol period and wake up from frightening dreams, where I could not sort out reality from the dream, panic and adrnelaine, rigid body and scared for my life.
The low cortisol periods throughout the day were vicious - crying jags, and real thoughts of suicide.
I even had some manic periods or euphoric times, which were just as scary.
Soo.....had to give that up.
I did taper down 2.5 mg/week, as reccommened by my dr and by internet folk who have had to go off HC.
It has been a downward spiral since August, when I tapered off.
The Seroquel is really throwing me for a loop.
The combo Luvox and Seroquel has NOT been good. Bad side effects. I was thinking of asking the dr if I could try Lexparo, which is what I used to take. I never had any bad effects from this combo.
I will never know if I had bad adrenals to begin with. I only know that I was stable on 25mg Seroqeul (the lowest taper I had gone to) for a year and a half. And once the HC treatment began, the Seroquel sent me into low cortisol periods.
Now, even off the HC, the Seroqeul is removing what little HPA axis function and cortisol I have avaialble while I am supressed.
I suspect that my treatment on thyroid meds during this period may have helped my adrenals, but I don't know what status they are in now.
Ideally, I would like to get off the Seroqeul, and keep with an SSRI like Lexapro to perk me up and maybe get back on the thyroid meds, if my adrenals can tolerate it.
My dr told me that it was likely sometime during my taper of Lexapro while I was on thyroid meds, that sent me into my "intolerance", by reducing my available cortisol ( I was still on 25mg Seroqeul).
I had no idea at the time what I was doing when I was tapering the Lexapro. I was guided by the information concerning SSRIs effects on thyroid hormones and thought it counterproductive to take something that reduced my circulating thyroid hormones, while I was taking thyorid meds!
Oh,well, :_(
Thanks for your suggestions. When I get back in some shape, I am going to work on more alternative therapies and see if I can get the thyroid straightened out.
Posted by Roslynn on September 24, 2008, at 17:46:11
In reply to Re: Best SSRI for post-steroid HPA((Bleauberry)), posted by nuala on September 24, 2008, at 17:30:09
Hi,
You are way more scientific in your approach to cutting Seroquel than I am! Good for you.
Anyway, I was at 50, cut down to 25, no real problems. Trying to reduce from the 25--I've tried three times. I'm finally down to the 12.5 (and sometimes less) but as I mentioned, the crying comes on.I'm stopping Seroquel due to cognitive problems--it was slowing my thinking down. I was forgetting a lot. It may have also contributed to my weight gain which has reached an unhealthy level.
Originally I was taking it for sleep and agitation/panic. It did work but now I am paying the price.
Roslynn
Posted by nuala on September 24, 2008, at 18:44:08
In reply to Re: Best SSRI for post-steroid HPA(nuala), posted by Roslynn on September 24, 2008, at 17:46:11
When I was doing my taper ages ago, I was able to cut down from 50 to 25mg Seroquel. I did not have a problem really, and just halved it at the time.
I had tried to reduce the 25 a few times as well. Once I got some 25mg sample pils from my pdoc and tried halving it. Did not work.
This attempt I decided to do it slowly. I had an integrative medicine physician tell me that she got one of her clients off it, who incidentally also had thyroid/adrenal issues. She recommended I taper VERY SLOWLY as she said. Her words have stayed with me.
At this point I have so many things going on, that I can't tell where the anxiety comes from. So, it became a bad tme to taper. But, spending a few weeks at a 2.5 mg drop seemed to work.
I had to speed it up when the adrenal suppression issue made it a necessity. I am afraid at each step of increasing my anxiety from the taper....but at the same time I know the Seroqeul is causing more anxiety from its anti cortisol property.
When I feel like this, I begin to doubt that I am dealing with psychiatric manifestations of a physical illness, and am convinced that I am regressing to some height of "mental illness". I can't wait till I get stable again.
Good luck!
Posted by Phillipa on September 24, 2008, at 19:34:22
In reply to Re: Best SSRI for post-steroid ((Roslynn)), posted by nuala on September 24, 2008, at 18:44:08
Why would you have to go off your tnyroid meds I was told it was forever??? Love Phillipa
Posted by bleauberry on September 24, 2008, at 20:14:20
In reply to Re: Best SSRI for post-steroid HPA((Bleauberry)), posted by nuala on September 24, 2008, at 17:30:09
It is interesting to see the different cultures at different forums. At Yahoo forums specializing in things like thyroid, adrenal, and metal toxicity, it is almost unheard of to take prescription meds. All the focus is on the correct supplements. Medications are a last resort and almost taboo. Here at pbabble it is the opposite. Here all the focus is on meds with hardly any real attention paid to supplementing the body with what it needs.
It is almost as if people think it is either one or the other, where I think it should be equal amounts of both. I know a lady in town for example that has found good stability with a combo of 50mg amitriptyline (a decent replacement for seroquel, by the way), low dose Isocort, siberian ginseng, and astragalus.
Might want to take a good look at licorice, siberian ginseng, and astragalus, in addition to your chosen medication. Maybe a tiny wee bit of armour thyroid too. Support the adrenals and thyroid and less meds would probably be needed. With the severe reactions you've had though, might be wise to keep all doses of meds and supplements on the extremely low side to start and gently increase over an extended period of time. From what I understand at other forums where people know a ton about this stuff, adrenals and thyroid treatments need to stay at a particular dose for a long time, like a month, before making any changes, and all changes including the starting dose should be in very small increments. People seem to suffer huge when they don't follow those guidelines, and people seem to do a lot better when they do.
Sure wish you felt better. I hope that scary adrenaline stuff is behind you. I've had that happen a lot too and it is worse than hell. Still happens sometimes. I hate it. Comes with the territory whenever mercury and lead are involved.
Posted by nuala on September 24, 2008, at 21:31:25
In reply to Re: Best SSRI for post-steroid HPA((Bleauberry)) » nuala, posted by bleauberry on September 24, 2008, at 20:14:20
I know what you mean about the different cultures on the web. I have run into the same problem with physicians/pdocs. I have bounced back and forth among endocrinologists, gps, integrative medicine, and psychiatry. The endos don't want to hear about the psych aspects, even though there is clearly much in the literature (endo texts included....hello endos, ever heard of neuroendocrinology????) about endocrine disease and mood disorders etc. Likewise with the pdocs. They all sagely nod about the effects of my endocrine diseases, but keep giving me meds that later I find out through reading on pubmed clearly are at odds with my condition.
It is very frustrating.
I have visited healthboards, and a good number of people on the addisons and thyroid boards have been prescribed psych meds, either before a diagnosis or along side it, as their conditions are not treated sufficiently to warrant going off the psych meds. So, I don't feel so alone. I feel alone without real medical guidance, however. That is the most frustrating thing. Talk about how many times I have been humilated by docs who really had no idea what they were talking about. And got even angrier if I brought literature to support my treatment wishes!
I have also visited realthyroidhelp where there are scores or people who are concerned with hormonal treatments, as well as supplemnts etc, and do talk to some extent about the psych problems associated.
I am a big fan of supplementation, I have tried lots of things, believe me, and have gotten some relief. Unfortunatley, at this point, even though my adrenals would do well to have some b vits etc, I can hardly tolerate anything at this point. I have read posts by such people in the past and thought they must be imagining that they were so sensitive. Well, now I am one. Can't believe it. Even digesting a meal takes its toll.
When I get back in some shape to tolerate things again, I will work on a more holistic view toward healing.
I read that I may be looking at 2-5 months HPA axis suppression, with a max of 12 months for adrenal function. I am hoping I am one of the lucky ones.
Thanks for your support. :-)
Posted by nuala on September 24, 2008, at 21:34:16
In reply to Re: Best SSRI for post-steroid ((Roslynn)) » nuala, posted by Phillipa on September 24, 2008, at 19:34:22
Thyroid meds are usually for life, though not always.
In my case, due to my degree of adrenal insufficiency, the thyroid meds were making me ill.
It is more common than you think, and a big problem, possibly without a solution for me.
Posted by Phillipa on September 24, 2008, at 23:59:06
In reply to Re: Best SSRI for post-steroid (Philipa), posted by nuala on September 24, 2008, at 21:34:16
Oh course I believe you just don't understand as I have autoimmune thyroiditis and was told that if I stopped synthroid I'd die? Any good links you would recommend? Thanks Phillipa
Posted by Bob on September 25, 2008, at 13:26:12
In reply to Re: Best SSRI for post-steroid HPA axis suppression?, posted by bleauberry on September 24, 2008, at 17:04:39
> Though slow and gradual, the proper eating strategy can help adrenals a lot. No caffeine, no or very low sugar, mostly proteins and low-sugar veggies, low carbs, only low-sugar fruits (berries), lots of clean purified water. Basically heavy on chicken, beef, eggs, and veggies.
>
Where are you getting your information on diet an adrenals? I would like to read more.- Bob
Posted by bleauberry on September 25, 2008, at 19:33:44
In reply to Re: Best SSRI for post-steroid HPA axis suppression? » bleauberry, posted by Bob on September 25, 2008, at 13:26:12
>
> > Though slow and gradual, the proper eating strategy can help adrenals a lot. No caffeine, no or very low sugar, mostly proteins and low-sugar veggies, low carbs, only low-sugar fruits (berries), lots of clean purified water. Basically heavy on chicken, beef, eggs, and veggies.
> >
>
> Where are you getting your information on diet an adrenals? I would like to read more.
>
> - Bob
>My doctor loaned me a book. There is an entire book by a female doctor who treats adrenals this way. She claims good success. The book is The Schwarzbein Principle II, by Diana Schwarzbein, M.D.
She emphasizes that it is a long process that takes months and even over a year for some people, and that there is a period early on that feels like you are getting worse instead of better. That is supposedly the time when body energy is going into healing, and when hormones are changing and readjusting.
Posted by Marty on September 26, 2008, at 21:19:23
In reply to Re: Best SSRI for post-steroid HPA axis suppression?, posted by bleauberry on September 24, 2008, at 17:04:39
> So why lexapro, I don't know. Just going by what I saw at pubmed.
---
Hypothesis: Norepinephrics tend to stablilize cortisol level and serotonegircs tend to increase/stimulate cortisol level... Lexapro being the purest of ALL SRIs with any significant affinity for norepinephrine receptors/transporter.. it's the one who stimulate the most elegantly cortisol release ?I didn't search it out. I'm just basing this hypothesis on what you report in your post. Just trying to make sense of everything with the fact that Escitalopram is by far the most selective of the SRIs.
/\/\arty
Posted by Nuala on September 27, 2008, at 8:48:39
In reply to Re: Best SSRI for post-steroid HPA axis suppression? » bleauberry, posted by Marty on September 26, 2008, at 21:19:23
I see my pdoc on Monday. I feel I should ask him to go back on the Lexapro, and not continue with the Luvox.
I have not felt right on it, and am hovering at a very tiny dose, just enough to prevent me from feeling that "black, i've-got-to-check-into-the psych-unit anxiety". I am very sensistive to medication.
Right now I am on 7.5 mg Seroquel and 10 mg Luxov. (I take the little beads out of the capsule and put thenm in an new gel cap) Been on it a total of 10 days.
Its one action is seemingly good, it seems to be evelating the HPA axis, or something, as I am not in a complete physical and mental panic. I could surely use a higher dose, but something very frigthening happened at 25mg, non-stop tachichardia for two days, plus other symptoms.
I found out that Luvox can increase the metabolism of Seroquel and has some possible interactions. So, it is working aginst what I need the SSRI to do, as it is extending the Seroquel and therefore, continuing to depress ACTH and cortisl production throughout the day.
I don't know why the pdoc gave this to me????
My only reservation about Lexapro is that is may increase my anxiety? The pdoc said Luvox had an anti anxiety property. But, I am thinking that at 10mg, I may be just experiencing a little lift in the HPA axis and THAT is reducing my anxiety - so why not a better SSRI for the job, like Lexapro I wonder?
If you have any advice on whether Lexapro would help, I would be grateful.
This is the end of the thread.
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