- This topic is empty.
-
Posts
-
In a post below, Dr. M states that higher dose melatonin can be counterproductive if one has depressed cortisol output.
Does GABA (which can also be used for sleep) have the same problem? What’s a good sleep dose?
@chaos 675 wrote:
In a post below, Dr. M states that higher dose melatonin can be counterproductive if one has depressed cortisol output.
Does GABA (which can also be used for sleep) have the same problem? What’s a good sleep dose?
The problem I have when using GABA with patients is that the dose necessary to help reduce anxiety or help sleep was so high that it would last too long and cause daytime fatigue and oversedation. These effects would be intolerable in a functional person.
GABA doesn’t have as much of a problem with cortisol as Melatonin has.
@BlackJack 678 wrote:
SO since gaba is a waste.. maybe try L-Glutamine to increase GABA?
Some people benefit from using GABA. Thus it isn’t a waste to them.
I find that if I take a 750 mg capsule (vs 750 mg caplet), I sleep well, reduce anxiety, and don’t have brain fog in the morning.
My experience is that Gaba didn’t work very very well for me and my wife for sleep and we tried fairly high doses. I might give a try to l-theanine someday to see if it works better. I tried it for anxiety and it was like a sugar pill to me.
@DrMariano 676 wrote:
The problem I have when using GABA with patients is that the dose necessary to help reduce anxiety or help sleep was so high that it would last too long and cause daytime fatigue and oversedation. These effects would be intolerable in a functional person.
GABA doesn’t have as much of a problem with cortisol as Melatonin has.
Couldnt agree more, tried diazepam and was the only thing to help me with adrenal fatigue. But most of the day i was sedated,tired and sleepy Its not great help, just some vere urgent times or unbearable ones.
Dr. M you think there will be some guideline to treat adrenal fatigue conditions in the future??
Its a killer situationI have used GABA without much benefit. But i have certainly noticed feeling worse and more lethargic when using melatonin. The next day the fatigue is worse, as Dr Mariano said due to lowering cortisol output and my levels are already low.
@Shaolin 828 wrote:
Couldnt agree more, tried diazepam and was the only thing to help me with adrenal fatigue. But most of the day i was sedated,tired and sleepy Its not great help, just some vere urgent times or unbearable ones.
Dr. M you think there will be some guideline to treat adrenal fatigue conditions in the future??
Its a killer situationA benzo helped HPA dysfunction? how?
What do you mean HPA function?? it helps if noradrenaline/stress levels are high to control the stress response. Yet nowadays antidepressants are used more for that reason. Are you referring to low HPA function, maybe it can help there too if you are still under high stress levels..
@Shaolin 828 wrote:
Couldnt agree more, tried diazepam and was the only thing to help me with adrenal fatigue. But most of the day i was sedated,tired and sleepy Its not great help, just some vere urgent times or unbearable ones.
Dr. M you think there will be some guideline to treat adrenal fatigue conditions in the future??
Its a killer situationTreatment of Hypothalamic-pituitary-adrenal axis dysregulation (which includes “adrenal fatigue”) is relatively straightforward. In concert, these areas are addressed:
1. Reduce nervous system excessive norepinephrine/stress signaling. This can be done by reducing environmental stresses, changing behavior, addressing psychological stresses, using psychiatric medications (which target primarily nervous system signaling problems), etc. Since excessive norepinephrine/stress signaling may be also a compensation for impaired energy production, addressing signaling and metabolic-nutritional problems contributing to impaired energy production is important to reduce compensatory activation of the stress system. This includes suboptimal thyroid, cortisol, iron, B-vitamins, Vitamin A, and other nutrients.
2. Reduce immune system excessive pro-inflammatory cytokine signaling. These ultimately may be what causes HPA Axis dysregulation. They are stimulated by excessive norepinephrine/stress signaling, but they may also be increased in other conditions such as chronic infections. Sometimes supportive treatment using Cortisol/Hydrocortisone or other Glucocorticoids, and/or other other adrenal cortex hormones are used. Improving Omega-3 to Omega-6 balance is important. Improving function of anti-inflammatory signals and reducing pro-inflammatory signals are important. For example, thyroid hormone, testosterone, etc. anti-inflammatory. Insulin, Leptin, etc. are pro-inflammatory.
3. Addressing metabolic-nutritional problems that impair nervous system, endocrine system, immune system function. For example, the lack of adequate animal sources of protein and fats impairs cellular metabolism and neurotransmitter production. The lack of adequate fat soluble vitamins may impair thyroid and other hormone signaling. The lack of adequate minerals such as iron may impair metabolic functions in general.
Of course, this is a simplification of all the factors involved. But these are the three areas I would examine when someone comes in with a complaint of “adrenal fatigue”.
The psychiatric medications are extremely useful since in general, the vast majority target reduction in norepinephrine signaling as an endpoint (outside of the stimulants and medications that increase norepinephrine). This is where I have an advantage as a psychiatrist. Many cardiovascular medications have psychiatric uses also in this regard – which psychiatrists are familiar with but other physicians may not have familiarity.
If anything, the major target (which most psychiatrists do not realize since they don’t take endocrine function into consideration) of treating person with an antidepressant or mood stabilizer is correction of hypothalamic-pituitary-adrenal axis dysregulation.
@DrMariano 874 wrote:
If anything, the major target (which most psychiatrists do not realize since they don’t take endocrine function into consideration) of treating person with an antidepressant or mood stabilizer is correction of hypothalamic-pituitary-adrenal axis dysregulation.
Could an SSRI antidepressant be useful in this regard/ Or do you generally prefer another class?
@chaos 897 wrote:
Could an SSRI antidepressant be useful in this regard/ Or do you generally prefer another class?
An SSRI may be useful depending on the patient’s circumstances. For example, does the person have a deficit of serotonin? How is the dopamine system functioning? How much in excess is norepinephrine? What is their iron level? How much serotonin is being produced? What is their tryptophan intake? What is the person’s level of sexual function? What is the person’s capacity to concentrate and remember things? How good is impulse control? How significant is environmental or psychological stress? What is the person’s age? How susceptible is the person to anticholinergic effects? What is the person’s weight and is the person trying to lose weight? What is the risk of the person committing suicide? Etc. There are a lot of variables to consider when considering an SSRI as a treatment.
The selection of medication (s) and class of medication (s) depends on the individual patient’s condition and situation.
@DrMariano 901 wrote:
An SSRI may be useful depending on the patient’s circumstances. For example, does the person have a deficit of serotonin? How is the dopamine system functioning? How much in excess is norepinephrine? What is their iron level? How much serotonin is being produced? What is their tryptophan intake? What is the person’s level of sexual function? What is the person’s capacity to concentrate and remember things? How good is impulse control? How significant is environmental or psychological stress? What is the person’s age? How susceptible is the person to anticholinergic effects? What is the person’s weight and is the person trying to lose weight? What is the risk of the person committing suicide? Etc. There are a lot of variables to consider when considering an SSRI as a treatment.
The selection of medication (s) and class of medication (s) depends on the individual patient’s condition and situation.
I ask because my doctor put me back on prozac and not only is my anxiety greatly reduced, my fatigue seems less.
I don’t know if that’s a mental thing or not. When i first started taking it again, I was REALLY sleepy. After about a week, that seemed to reverse.
@chaos 931 wrote:
I ask because my doctor put me back on prozac and not only is my anxiety greatly reduced, my fatigue seems less.
I don’t know if that’s a mental thing or not. When i first started taking it again, I was REALLY sleepy. After about a week, that seemed to reverse.
Congratulations. I am happy it helps you.
SSRIs increase serotonin signal duration. Increasing serotonin signaling (so long as thereis sufficient serotonin being reduced) can lead to decreased norepinephrine signaling (if dopamine isn’t reduced excessively by the increase in serotonin), which can lead to decreased pro-inflammatory cytokine signaling, which can help resolve hypothalamic-pituitary-adrenal axis dysregulation – if one doesn’t have other complicating factors. The main reason depression is generally better after several weeks – if one is lucky – with an antidepressant is this improvement in hypothalamic-pituitary-adrenal axis regulation. With improvement in HPA axis regulation, cortisol signaling improves, then thyroid signaling improves, and so on, until a person is hopefully in remission.
Notice that it is a long chain of events that has to occur, starting with the availability of serotonin production so that the SSRI can work in the first place via its primary mechanism. Since there are a lot of complicating factors that prevent this chain of events from being successful, there are many reasons antidepressants may only partially work or not work at all. Addressing these other factors – which are themselves often causes of depression – helps improve treatment outcome.
SSRIs are very useful medications in the psychiatric toolkit when one knows how to use them as part of an overall scheme of treatment.
- You must be logged in to reply to this topic.