SSRI Burnout and Hormone Experiences

[SeriouslySteve]

Hello,

Thanks to all the great contributors in these forums–I have really learned a lot so far. I have pasted some laboratory values below should anyone choose to reference them, but wanted to ask a few general questions regarding HPA Axis Dysregulation.

I am a 28 year old male and have been suffering from severe fatigue, weight gain, insomnia, anxiety, depression, and sexual dysfunction for almost three years. (In actuality, I suffered from anxiety and depression as far back as age 14, but the symptoms had been well-managed on Zoloft. When they returned recently, they were of a different quality. I worry constantly, but at the same time don’t have enough energy to care. Bizarre.) Fearing that excessive norepinephrine was to blame, I slowly weened off of Zoloft. I also weened off of Wellbutrin, which my PCP had suggested to boost energy.

I have found a naturopathic doctor who agreed to prescribe Armour, but seemed to do worse on it. He suggested trying Hydrocortisone to address any adrenal involvement, but has warned me that he is wary of exceeding 10-15mg at the max. With my first dose of 5mg this morning, I felt a subtle stream of energy that seemed to help me with my day.

My questions:
1) Has anyone experienced SSRI “burnout”? Is there any thought on what this might be? I’m concerned there may be some sort of receptor damage or a destroyed feedback loop somewhere if this is what’s going on.

2) Has anyone done well on sub-replacement doses of HC when combined with natural thyroid?

Thank you,
SeriouslySteve

LABS
Vitamin D, 25-Hydroxy 73.0 ng/mL (30-80)
Estradiol 21 pg/ML (11.6-41.2)
Ferritin 124.8 ng/mL (26.0-388.0)
TSH 1.75 uIU/mL (.45-4.5)
Free T3 2.5 pg/mL (2.18-3.98)
Free T4 .98 ng/dL (.76-1.46)
Thyroid Peroxidase .8 IU/mL (.0-9.0)
Testosterone 381 ng/dL (300-1200)
CRP High Sensitive <0.2mg/L (<3.0)

Adrenal Saliva Index BioHealth Diagnostics 10/2010 (While on Zoloft 50mg/day)
CORTISOLS
Morning 11.4 nM (13.0-24.0) LOW
Noon 5.9 nM (5.0-8.0)
Afternoon 2.3 nM (4.0-7.0) LOW
Nighttime 1.5 nM (1.0-3.0)
Cortisol Sum 21.1 nM (23.0-42.0) LOW

DHEA-S Avg. 3.17 ng/mL (2.0-10.0)
Cortisol/DHEA-S Ratio 6.7 (5.0-6.0) HIGH
Salivary Estradiol 2.8 pg/mL (1.0-3.0)
Salivary Estriol 2.2 pg/mL (0.0-3.0)
Salivary Progesterone 57 pg/mL (5-100)
Melatonin PM 10.1 pg/mL (12.0-23.0)
Testosterone AM 81.6 pg/mL (40-130)

Adrenal Saliva Index Sabre Sciences 12/02/2011 (While on Wellbutrin 300mg per day)
CORTISOLS
8AM 5.75 ng/mL (3.5-6.3)
Noon 2.73 ng/mL (1.4-2.8)
4PM 1.93 ng/mL (.8-2.4)
8PM 1.5 ng/mL (.6-1.6)
Midnight 1.15 ng/mL (.3-1.2)
4AM 1.95 ng/mL (.3-1.7) HIGH

DHEA-S
8AM 4.2 ng/mL (2.8-12.7)
8PM 5.0 ng/mL (2.7-9.0)
Midnight 3.0 ng/mL (1.8-8.1)

CBC SCREEN 11/2011
WBC 3.8 K/mcL (3.8-11.0)
RBC 4.78 M/mcL (4.5-5.9)
HGB 15.3 g/dL (13.5-17.0)
HCT 44.4% (41-53)
MCV 92.7 fl (80-100)
MCH 32.1 pg (26-34)
MCHC 34.6 g/dL (31-36)
RDW 11.4% (10.5-13.5)
Platelet Count 201 K/mcL (150-450)
Neutrophils 47.4% (44-70)
Lymphocyes 43.1% (25-46)
Monocytes 7.0% (1-12)
Eosinophils 1.6% (0-8)
Basophils .9% (0-2)
Absolute Neut Ct 1.8 K/mcL (1.8-7.7)
Absolute Lymphs 1.6 K/mcL (1.0-5.0)
Absolute monos 0.3 K/mcL (0-0.8)
Absolute Eos .1 K/mcL (0-.5)
Absolute Baso 0.0 K/mcL (0-.2)
NRBC 0.0/100 (0)

COMPREHENSIVE METABOLIC PANEL 11/2011
Sodium 141 mmol/L (136-146)
Potassium 4.3 mmol/L (3.5-5.1)
Chloride 103 mmol/L (98-107)
Glucose 76 mg/dL (70-140)
CO2 27 mmol/L (22-32)
BUN 16 mg/dL (7-21)
Creatinine 1.2 mg/dL (.7-1.3)
Calcium 9.1 mg/dL (8.4-10.3)
Albumin 4.3 g/dL (3.3-5.0)
AST 24 Units/L (15-37)
Protein, Total 6.9 g/dL (6.0-8.0)
Bilirubin, Total .7 mg/dL (.1-1.2)
ALT 39 Units/L (12-78)
Alkaline Phos 36 Units/L (38-126) LOW
GFR Calc, Non-African 77 mL/mn/1.73 (>60)
GFR Calc, African 94 mL/mn/1.73 (>60)
Osmo Calc 292 mOs/Kg H2O (280-305)

URINALYSIS 11/2011
Clarity Cloudy (Ref: Clear) FLAG
Specific Gravity 1.021 (1.005-1.030)
pH 8.0 (5.0-8.5)
Protein Negative mg/dL (Neg)
Glucose Negative mg/dL (Neg)
Ketones Negative mg/dL (Neg)
Bilirubin Negative (Neg)
Occult blood Negative (Neg)
Nitrite Negative (Neg)
Leuk Esterase Negative (Neg)
Urobilinogen 0.2 mg/dL (<2.0)

[Jules]

Hey there,

I had a similar thing happen to me also.
I’ve been healthy, very healthy, my whole young life, active, fast metabolism, but I always had anxiety and depression. After a stressful/upsetting event, my GP put me on venlafaxine, I was on it for 10 mths, I still had good energy etc on it but I developed hypertension and facial fluid retention which was quite noticeable (resembled ‘moon face’) which was odd because i was thin and active. i weaned off, pretty quick, over 2 mths, horrible withdrawal, and once the withdrawal was overwith, I was extremely “hypo” – weight gain ,constipation, low stomach acid, dizziness, serious hypotension, hypoglycemic, hair loss, dry skin, trouble sleeping, profound exhaustion, low neutrophil count, etc.

Anyways I’ve been this way for 2 yrs now, I tried the natural route under an integrative physician – vitamins, herbs and such – and I’ve been diagnosed by 2 MDs as hypocortisol, based on symptoms, signs, ruled out hypothyroidism, and a really really low saliva free cort. result.

it seems like downregulation of the HPA axis is occurring for some people with the use of these drugs. I know hypercortisol is bad, but hypocort is bad too.

I really hope they figure this stuff out.

I did low dose and replacement-dose hydrocortisone for a while and I’m slowly weaning back and starting to feel more ‘hypo’ again. It helped me also, I felt warmer, my hair grew back, I lost some weight, etc. But I can’t see it being a long-term solution. and now that i’m slowly weaning off of the HC (2mg every 2 weeks or so) i have to figure out another solution, and i’m worried about rebound inflammation and possible autoimmune issues. i dont have autoimmune disease, but i’m beginning to experience pinching in arms and hands and my GP thinks there may be inflammation so sending me for tests. possible arthritis. i’m 26!!

What worries me, is that elevating 5HT and NE levels increases or stims. CRH, at least acutely, so do these drugs do something to the interaction bw 5HT neurons and the HPA. Or, these drugs also observed to increase MR and GR expression in the hippocampus, and that would also decrease HPA activity, so is it that?

[SeriouslySteve]

Jules,

Sorry to hear about your situation. I was able to get a good decade or so out of zoloft, but began having problems about three years ago at age 25.

I am not very well-versed on neurotransmitter involvement, but I can say that I have symptoms of both hypothyroid and HPA dysregulation (which, of course, could indicate several other problems as well). I originally had a flat-lining salivary cortisol curve, but it rebounded after I ditched a low-carb diet I was on at the time. Since then, it has gone too far in the opposite direction (high in-range all day and out-of-range at night).

I thought the HC was helping, but I fear I spoke too soon. Having divided and increased the doses I can barely tell a difference between the hour before and the hour after my dose. This is not very different from normal for me.

Can I ask how long and what your dose of HC was before you weaned? It seems like it may have been helping. Would you consider going back on it or is it not worth it to you?

[Jules]

Hi there,

So if you’ve got a decade or so on these drugs, and you’re only in your late twenties..you went on them pretty early on eh??

Actually, I’ve weaned down on cortef but not totally off, and I’ve gone back up too. This time around I am around 22mg at this time, come down from a high dose actually, it’s been really rough, losing my hair and losing my appetite and such, but im going super slow (2.5mg every 10-12 days or so, or 2 weeks). i’m not feeling too too terrible now.

but i am very low cortisol, like dizziness, very low blood pressure, symptoms that looks like hypothyroidism (dry skin, low appetite, sluggish digestion) but i am not hypothyroid. low cort can look like hypothyroidism. but if i take thyroid hormone or anything that makes thyroid work more efficiently (like iron, b12), i get adrenaline right away, hypoglycemia, that type of thing so i know its my hpa output is too low because that’s a symptom of low cort. the thyroid uses up the cort.

the thing i find interesting is that these drugs (antidepressants) have been observed to increase the glucocorticoid and mineralocorticoid receptors in the brain, which increases negative feedback of cortisol and results in the pituitary shutting down its ACTH sooner – which results in lower cortisol levels. and since many people get this low cortisol thing after coming off of an antidepressant, i wonder if this is what’s at work.

there’s alot of studies being done on the HPA axis, to try and understand it better, its not very well understood. hypercortisolism seems to be associated with depression, insulin resistance, hypocortisol seems to be associated with chronic fatigue, atypical depression, post-traumatic stress disorder.

if your cortisol is high now, you’re lucky, its easier to lower cort. levels than it is to raise them. best things to lower cortisol is probably vit C and magnesium. and ginger and garlic. i have to stay away from all those things. so you were low, and then you stabilized and now you’re high? or are you still on the HC. u know if you take the test while you’re on hydrocortisone it will be useless. mine was also very very low and flatline and i havent measured it since.

cortef has been kind of a life saver, i was extremely hypocort. for a yr after coming off of effexor, and nothing changed, so when i finally got on cortef i improved right away like 30%. but its been more or less the same over the last 10 mths. ive been on lower doses and ive been on higher doses. higher doses i feel less ‘hypo’ i have better circulation, more appetite, i lose weight, my hair gets more thick.

the thing is, to stay on cortef long time isnt good because your adrenal glands and pituitary get lazy and can potentially stop working. my dr. prescribed me 20mg and wishes me to stay on it, but id like to give it a chance and try to get them to do a little more work so i’m taking my time to come down and get off of it. supposedly 20mg is a non-suppressive dose, but i’ve been on doses like 40mg so im sure there’s been some suppression in there at some point.

if i feel like shit after i get off, and nothing changes, i’ll probably give it some time and then figure out whether i want to go back on the cortef or else i have no idea what else i can do. i dont want to go the antidepressant route because 1) i am not depressed 2) i dont want to go thru withdrawal all over again which i would eventually have to do 3) it may not even increase my cortisol levels and so itll be big risk with no reward. 4) it could make me feel worse

the problem with the current medical treatments for low cortisol, is, Drs. treat it often like an immune dysfunction, and i’m sure in alot of cases, it is, but in some cases, it is certainly not. i dont have any infections or viruses or allergies or any of the rest of that. my body just produces very little cortisol now. a clean diet and lots of vitamins and cleanses dont work for me – they actually seem to make me feel much, much weaker and more hypocort.

[Author]

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