I’ve have been suffering from low energy/depression beginning at age 19. This came on shortly after moving to Alaska, with presenting symptom with insomnia.

I was put on Amitriptyline. I have taken it ever since then with the exception of 1 year in which I stopped due to wanting to conceive. I slept anywhere from 4-6hrs a night at the most. After the birth of my girls, I tried to stay off it, but was getting worn out & began taking it again.

I’ve had symptoms of increased depression slowly intensifying noticeably in my late 30’s. I am 53 years old now.

Having some knowledge & interest I began studying natural medicine-herbs etc… searching for a cure.

With all my studying I feel I have adrenal insufficiency for 15 years or so & needed physiologic dosing with low dose Hydrocortisone 4-5 times a day.

Now, I’m convinced I still need that, along with Armour Thyroid.

I had a comprehensive 24hr urine done to test hormones/steriods/hgh. I had it done at Meridian Lab near the Tahoma clinic in Kent Washington. The labs were sent to my PC Physician showing extremely low steriods and no Cortisol E or F. He isn’t convinced they are accurate & drew a blood cortisol level & wants to do one again Friday morning.

I’ve not a morning temperature above 96.9 F, for weeks before getting out of bed. I have symptoms of adrenal insufficiency & Hypothyroidism.

I can’t seem to get through to him.

Are these blood Cortisol levels he wants down x2 going to be helpful?

Shouldn’t he go by the results of the 24hr urine?

Do you people have any suggestions? Help!! I want to enjoy life, not just get through it.

I generally prefer using standard blood and urine tests. The cost is generally lower than by using comprehensive 24-hour urine tests. They often are covered by health insurance, unlike the alternative medicine lab tests.

I can also test for many more health issues contributing to mood problems with the standard blood and urine tests.

The biggest advantage of a blood test over a 24-hour urine test is that it also helps determine dosing.

Assessment of a 24-hour comprehensive urine test is complicated. It is also a non-standard test. Thus, unless your doctor is versed in alternative medicine, he will not know how to evaluate it.

When assessing adrenal function, I prefer doing standard blood tests.

Some tests to commonly considered include:

Cortisol
DHEA-s
Pregnenolone
Progesterone (best in the follicular phase for women)
Estradiol (best in the follicular phase for women)
Testosterone
Aldosterone – if dizziness, hearing problems, blood pressure are concerns, for example.
Fractionated Plasma Catecholamines (includes Epinephrine, Norepinephrine)
ACTH – optionally, if pituitary dysfunction is present.

When doing an assessment using blood tests, it is useful to get a broader sample of some of the adrenal hormones, not just Cortisol. This allows one to make a better assessment of how each section of the adrenal glands may be responding to signals from the nervous system, endocrine system and immune system and their metabolic function. Each of the hormones has specific roles in the response to stress.

A single Cortisol level, however, still has usefulness. It can be negatively correlated with inflammatory signaling. When low, systemic immune system activity may be shifted to an inflamed. This is what can lead to sickness behaviors – which are symptoms of depression.

Low thyroid hormone can predispose one to depression.

Cold weather can predispose one to depression. Cold weather forces the nervous system to increase body heat generation by increasing sympathetic nervous sytem activity. This can cause insomnia. But it also can lead to increased inflammatory immune system activity that eventually lead to sickness behaviors and depression.

Suboptimal nutrition is a common contributor toward depression. Even when people think they have good nutrition, when nutritional analysis is done, they often are deficient in several nutrients. Modern diets are particularly deficient in numerous nutrients. A good starting point with diet is the book “Nourishing Traditions” by Sally Fallon. A problem in treatment is that often practitioners have not thought about what is an “optimal” as oppose to “deficient” level for individual nutrients when it comes to mental function. B12 deficiency, for example, starts at 550 pg/mL where neuron demyelination starts, not 200 pg/mL, where most would consider supplementation. Further, since B12 is artificially elevated by Folate, a higher dose may be necessary. A Methylmalonic acid level may also need to be checked to make sure B12 is even working. Iron deficiency is also often not recognized. A Ferritin level needs to be checked but often is not. Iron metabolism is also dependent on Vitamin A metabolism. Vitamin D is often deficient. However, I think current supplementation dosing guidelines are low compared to what people use to get in traditional diets. Mental health often needs higher dosing for Vitamin D. There are complexities involved with treatment that need to be addressed when one attempts to optimize nutrition.

Gastrointestinal problems – such as pathogenic bacterial or yeast infections, irritable bowel syndrome, etc. – are a common problem which can cause fatigue and depression.

Depression usually has multiple underlying pathophysiological causes. Suboptimal thyroid and suboptimal adrenal function are just two of the many problems that can exist simultaneously to cause depression. Mental function is highly preserved function. It takes a lot of hits to cause mental illness.

The problems can be stratified along four general groups:

Structural problems include neurodegenerative changes such as loss of glial cell mass or myelination, suboptimal intestinal flora.

Signaling problems include problems with norepinephrine, serotonin, dopamine, thyroid, inflammatory cytokines, adrenal hormones, testosterone, estrogens, leptin, insulin, renin-angiotensin-aldosterone, etc.

Metabolic and Nutritional problems include problems with gluconeogenesis, lipid metabolism, intestinal transport, mitochondrial function, problems with the citric acid cycle, signal transduction problems, nutritional deficiencies – of which a myriad are possible.

Psychological and social problems and stresses – of which there are a nearly infinite variety.

Achieving wellness involves identifying each individual problem which are contributing to depression and addressing them. The treatment interventions include psychosocial interventions, nervous system interventions (such as the psychiatric medications), endocrine interventions, immune system interventions, and metabolic and nutritional interventions. Thus, an comprehensive assessement and treatment is often needed. In psychiatry, this avoids trial and error work and achieves better results.

When one aims for wellness, the key to treatment is optimization of the various systems involved.

For example, when it comes to thyroid hormone, one not only has to adjust thyroid signaling until it is optimal, but to also address the nutritional aspects of thyroid function and to address immune system problems which can impair thyroid function.

When it comes to adrenal function, one has to address immune system problems, nutritional problems and nervous system problems that may cause dysregulation of the adrenal glands. These days, I, often, do not need to do adrenal signaling support by adding hydrocortisone or other hormones when I address the other systemic problems because adrenal dysregulation is often secondary to these other issues.