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High Cortisol and SSRIs


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brighteningup

 

 

See also:  early-morning-waking-managing-the-morning-cortisol-spike

 

 

[A BIG CAVEAT ON THIS POST :-

I AM NOT A QUALIFIED MEDICAL RESEARCHER AND THIS IS NOT ANY KIND OF META-ANALYSIS. THESE ARE SOME ARTICLES I HAVE FOUND LOOKING INTO THIS FURTHER ON THE INTERNET MAKING USED OF AN ACADEMIC RESEARCH DATABASE TOOL AND GOOGLE. I HAVE PROBABLY MISSED OUT SOMETHING IMPORTANT. THE INFORMATION HERE IS PRESENTED FOR INFORMATION AND DISCUSSION ONLY AND WILL BE INCOMPLETE]

 

I've been trying to understand how SSRIs interact with cortisol. I'm trying to do this as I think my cortisol levels have been messed about by use of topical corticosteroids and this may have been one of the very important factors in why I was originally depressed. I'm now trying to understand how taking citalopram (Celexa) for 6 months at 20mg followed by tapering may have impacted on this.

 

This is what I've found out and I thought I'd share it in case it is of interest to you too.

 

(Where I refer to particular studies I've put a number, the study name and a link to further info about them are listed next to the number at the end of this post).

 

Cortisol is a very important hormone that we produce naturally in our adrenal glands. Too much or too little of it isn't very good for us, a common condition when you have much too much cortisol is Cushings syndrome, whereas Addisons disease is when you have much too little.

From wikipedia:-

"Cortisol (hydrocortisone) is a steroid hormone, or glucocorticoid, produced by the adrenal gland. It is released in response to stress and a low level of blood glucocorticoids. Its primary functions are to increase blood sugar through gluconeogenesis; suppress the immune system; and aid in fat, protein and carbohydrate metabolism."

 

Wikipedia - Cortisol

 

The most common type of Cushings syndrome is iatrogenic Cushing's syndrome, caused by people being given glucocorticoids i.e. various steroid treatments, for various medical conditions. (I almost certainly did NOT have this but the topical corticosteroids I have used have almost certainly given me some of the symptons associated with Cushings).

Cushings syndrome

 

Addisons disease is usually caused by an auto-immune disorder and is pretty rare.

Addisons Disease

 

There is pretty good information on how taking corticosteriods can influence the body - basically overtime your body can start reducing the amount of steroids it produces naturally and this can be a problem so it is advised not to stop taking corticosteroids suddenly.

Best info I've found on corticosteroids and their side effects is here:-

NHS choices on corticosteroid side effects - http://www.nhs.uk/Conditions/Corticosteroid-%28drugs%29/Pages/Sideeffects.aspx

 

Incidentally treatment with topical corticosteroids is implicated in Cushings syndrome but it is rare.

Side effects - topical corticosteroids

 

I'm finding it much more difficult to understand how SSRIs effect cortisol.

 

The rather useul NHS choices lists the usual (very long) list of side effects it also lists withrawal effects too (and calls them this)

SSRI side effects

but it makes no mention of the effect of SSRIS on cortisol so I've had to dig a little deeper into the research literature.

 

What I've found is the situation is very complicated.

 

Complication number one

There seems to be some evidence that people with depression have elevated or varying cortisol levels in some way due to depression (this is mentioned in the wikipedia article above) - so unpicking the effect of depression on cortisol and the SSRI alone on cortisol is going to be difficult.

 

Complication number two

Whilst SSRIs seem to be having some kind of interaction with cortisol. It appears they may suppress it or increase it and this may be dependent on the SSRI and how long it is taken for. It seems unclear in the longer term what effects of this increased or decreased cortisol levels might be or how acute these might be (because nobody seems to have done any studies ion this).

 

Citalopram and Escitalopram (Celexa, Lexapro) appear to increase cortisol levels initially see (1) and a number of studies referred to in (2). The dosage might make a difference, in one study 20mg of citalopram didn't have an effect but 40mg did (3).

 

A lot of the studies I've found seem to be around these two anti-depressants - I'm not sure [without doing a lot more work] what the impact on cortisol of other antidepressants might be. Some of the studies are about stressing rats - rather than about people (I haven't included links to those ones here).

 

However, there is some help from this study

see here (4) below - you may find this is locked behind a pay wall so may only be able to see the abstract.

This study reviews a number of studies that look at the HPA axis* and SSRIs. They review studies which have meassured cortisol levels, they find a number of studies (7) that have found supression of cortisol levels after a course of treatment by SSRIs - they list the following drugs, mirtazapine (Remeron, Avanza, Zispin), amitriptyline (Elavil, Tryptizol, Laroxyl, Sarotex, Lentizol), citalopram (Celexa, Cipramil), paroxetine (Aropax, Paxil, Seroxat, Sereupin), Sertraline (Zoloft and Lustral). They then list a further 20 studies that have found no change in cortisol due to anti-depressants treatment though they don't list which drugs this applies to.

[The overall study which is a meta-anlayis to look at if antidepressant treatment is effecting coritsol levels, looks not just at SSRIs, but also at tricyclics, lithuim and ECT and finds less than half the studies show reductions in levels of cortisol.]

 

{* From wikipeda - HPA axis The hypothalamic-pituitary-adrenal axis (HPA or HTPA axis), also known as the limbic-hypothalamic-pituitary-adrenal axis (LHPA axis) and, occasionally, as the hypothalamic-pituitary-adrenal-gonadotropic axis, is a complex set of direct influences and feedback interactions among the hypothalamus, the pituitary gland (a pea-shaped structure located below the hypothalamus), and the adrenal (or suprarenal) glands (small, conical organs on top of the kidneys) see further Wikipedia - HPA}

 

A key problem is none of the studies are over the typical period someone takes an SSRI for - i.e 6 months plus (sometimes of course this is for years not months); they often look at a period of days or weeks, indeed a 4 week study called itself a long term study (2). The clinical trials are also generally with small numbers of patients.

 

A further issues seems to be that a majority of studies seem to be trying to work out whether cortisol levels can be used to assess how affective treatment is (4), rather than looking at whether the anti-depressants themselves might be raising or lowering cortisol levels and if this might be a problem of itself .

 

Complication number 3

Whether cortisol level increase or decrease as a result of taking SSRIs may depend on the individual as well as the SSRI.

One recent study seems to suggest that the impact on cortisol of SSRIs might also be affected by genetic differences

(5)

 

Changes in cortisol levels have not been found to be any predictor of treatment outcome in one small study [Note cortisol level do seem to change as a result of using an SSSRI in this case escitalopram] (A look at the full text of this {whihc you may find is stuck behind a pay wall for you} shows it was a small 8 week trial - 17 started - 12 completed. If I'm reading the results correctly the levels of cortisol seem to on average have increased within 90 minutes of takin escitlaloptam initially, overall it appears that for some in the trial levels of cortisol increase, for others it decreases).(6)

 

Concluding points

 

So it appears that SSRIs do interact with cortisol - but we can't really tell how or why, who will be effected, or which SSRIs and SNRIs are implicated in what way.

 

I find the lack of clear information on how SSRIs interact with cortisol over the long term very concerning - this seems like an area that needs way more research. I would conjecture that if SSRIs are influencing cortisol levels then this may explain some of the withdrawal effects that people experience. Also if some SSRIs are increasing cortisol, but others decreasing it, then swapping between an increasing type of cortisol SSRIS to a decreasing type of cortisol SSRI might lead to some rather difficult side effects (but if this also depends on individual factors this might be very difficult to predict).

 

It seems to me that IF taking SSRIs is suppressing cortisol this sounds disturbingly similar to some of the side-effects that people get when they take steroids - could it be that SSRI stimulate cortisol production so the body produces less naturally like steroids - and could it be this only happens to some people with particular genetic traits - if so shouldn't we be very cautious about how we use these drugs (as we now are with steroids...).

 

This area is (like many areas around anti-depressant withdrawal) crying out for some good quality research into the interactions between long term effects of SSRI use and SSRI withdrawal on cortisol.

 

However, if the interaction between cortisol and SSRIs is important for withdrawal, then in practical terms it probably just reinforces the slow taper advice on this site - since when reducing levels of corticosteroids it is also advised that you slow taper.

For example see the Mayo clinc advice on slow tapering the corticosteroid prednisone - Mayo clinic - corticosteroid tapering

 

Bright

 

References (Numbers noted above)

 

(1) BERARDELLI R et al (2010) Neuroendocrine effects of citalopram, a selective serotonin re-uptake inhibitor, during lifespan in humans, Journal of endocrinological investigation, vol. 33, no9, pp. 657-662

http://cat.inist.fr/?aModele=afficheN&cpsidt=23509222

(2) Knorr U, Vinberg M, Hansen A, Klose M, Feldt-Rasmussen U, et al. (2011) Escitalopram and Neuroendocrine Response in Healthy First-Degree Relatives to Depressed Patients – A Randomized Placebo-Controlled Trial. PLoS ONE 6(6)

http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0021224

No evidence of decreases incortisol levels over a 4 week period on 10mg of escitalopram in healthy individuals who were relatives of those who have a major depressive disorder for which they were treated in hospital - they study was undertaken because it has been suggested that people with a major depression and those with a family history of depression have higher cortisol

"The aim of the AGENDA trial was to investigate whether long-term intervention with SSRI versus placebo affects the cortisol response in the dexamethasone corticotropin-releasing hormone (DEX-CRH) test in healthy first-degree relatives to patients with major depressive disorder (MDD)."

"Previous studies have shown that even healthy first-degree relatives to patients with major depressive disorder (MDD) have an abnormal HPA response to the DEX-CRH test, with an intermediary response when compared to healthy controls and patients with major depression [2]. Furthermore, salivary cortisol has been shown to be increased in individuals with a family history of MDD as compared to healthy individuals without a family history of MDD [3]–[5]. Intervention with a single dose of a selective serotonin re-uptake inhibitor (SSRI) has been found to increase serum corticosterone levels in rats [6], [7] and plasma corticosteroid levels in healthy humans [8]–[12]. In rats plasma levels of HPA-axis hormones, corticosterone and adrenocorticotropic hormone (ACTH), decreased after 15 days intervention with citalopram [13]"{Numbers refer to articles quoted as references to this study - see the wblink below if you want to look these up futher}

"The present trial does not support an effect of escitalopram 10 mg daily compared with placebo on the HPA-axis in healthy first-degree relatives to patients with MDD. Increasing levels of escitalopram tended to decrease the HPA-response in the DEX-CRH test and this effect increased with age."

 

(3) Hawken et al (2006) Effects of oral racemic citalopram on neuroendocrine responses, Progress in Neuro-Psychopharmacology and Biological Psychiatry, Volume 30, Issue 4, June 2006, Pages 694-700

http://www.sciencedirect.com.ezproxy.webfeat.lib.ed.ac.uk/science/article/pii/S027858460600042X

 

(4) McKaya & Zakzanis (2010) The impact of treatment on HPA axis activity in unipolar major depression, Journal of Psychiatric Research, Volume 44, Issue 3, February 2010, Pages 183-192

http://www.sciencedirect.com.ezproxy.webfeat.lib.ed.ac.uk/science/article/pii/S0022395609001757

 

(5) Klock et al (2011) Common functional mineralocorticoid receptor polymorphisms modulate the cortisol awakening response: Interaction with SSRIs , Psychoneuroendocrinology, Volume 36, Issue 4, May 2011, Pages 484-494

http://www.sciencedirect.com.ezproxy.webfeat.lib.ed.ac.uk/science/article/pii/S0306453010001939

 

(6) Papkostas et al (2010) 5HT1A-mediated stimulation of cortisol release in major depression: use of non-invasive cortisol measurements to predict clinical response, European Archives of Psychiatry and Clinical Neuroscience, Volume 260, Number 2, pp 175-180

http://www.springerlink.com.ezproxy.webfeat.lib.ed.ac.uk/content/6633w8u177k16137/

Edited by ChessieCat
added see also

Citalopram for 6 months

Since then tapering off over last 4 months

20mg -> 15mg -> 10mg -> 5mg (roughly every 3-4 weeks)

Stayed at 2.5mg for approx 6 weeks

As of 9 Sept 2011 off citalopram

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  • Administrator

Good piece. Thanks, Bright.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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During this recent stetch of w/d my doctor (gp) became concerned about addison's. He ordered tests and determined... that I don't have it. Only about 3,000 people in the US do. He didn't find my explanation (prolonged psych med w/d) satisfying. He remains baffled still - but sleeps fine in spite of his bafflement.

 

I second your overall point about the cloudiness in the area we all deal. I'm not a neuro-scientist which, actually, isn't that relevant because it seems even neuroscientists aren't so far able to answer questions like yours with much predictive usefulness.

 

I hope you are doing well today, bright.

 

Alex.i

"Well my ship's been split to splinters and it's sinking fast
I'm drowning in the poison, got no future, got no past
But my heart is not weary, it's light and it's free
I've got nothing but affection for all those who sailed with me.

Everybody's moving, if they ain't already there
Everybody's got to move somewhere
Stick with me baby, stick with me anyhow
Things should start to get interesting right about now."

- Zimmerman

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  • Administrator

Your doctor is kind of on the right track. Rather than Addison's, withdrawal syndrome is more like a low-level iatrogenic Cushing's. Sometimes tests of the 24-hour cortisol level do show elevation, but there is no evidence of tumor.

 

Good that he's sort of supportive.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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I had a couple of measures out of range on bloodwork. They were only marginally out of range, not enough for diagnosis but suggested autoimmune dysfunction. I think maybe one was the ANA titer?

'

In any event, turns out, as you say, dysfunction caused by w/d not Addison's or lupus... The symptoms I had then -- plunging bp, vomiting, nausea, weakness, weight loss, digestive dysfunction, fainting upon standing, etc -- not all that dissimilar symptom-wise to some autoimmune disorders according to my physician.

 

Good news: these symptoms almost entirely resolved, except for the digestive problems which continue to bother me and continue to evolve.

 

Alex.i

"Well my ship's been split to splinters and it's sinking fast
I'm drowning in the poison, got no future, got no past
But my heart is not weary, it's light and it's free
I've got nothing but affection for all those who sailed with me.

Everybody's moving, if they ain't already there
Everybody's got to move somewhere
Stick with me baby, stick with me anyhow
Things should start to get interesting right about now."

- Zimmerman

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  • 4 months later...
Barbarannamated

Www.bollyn.com

 

Lots of info on cortisol -Prozac connection

Pristiq tapered over 8 months ending Spring 2011 after 18 years of polydrugging that began w/Zoloft for fatigue/general malaise (not mood). CURRENT: 1mg Klonopin qhs (SSRI bruxism), 75mg trazodone qhs, various hormonesLitigation for 11 years for Work-related injury, settled 2004. Involuntary medical retirement in 2001 (age 39). 2012 - brain MRI showing diffuse, chronic cerebrovascular damage/demyelination possibly vasculitis/cerebritis. Dx w/autoimmune polyendocrine failure.<p>2013 - Dx w/CNS Sjogren's Lupus (FANA antibodies first appeared in 1997 but missed by doc).

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  • 2 years later...

BRIGHTEN U IMOVU ARE RIGHT. MY MOTHER HAS HYPOPITUITARISM AND ADDISONS DISEASE.

 

I HAVE SEVERAL RISK FACTORS FOR TIGGERING THAT GENETIC PREDISPOSITION (NOT HEREDITARY).

 

I DIDCOVERED WHAT U DID ABOUT TWO MONTHS AGO.

 

OVER THE LAST 4 MONTH'S I HAVE SUCCESSFULLY WEANED OFF A TRYCYCLIC (WHICH IS THE FIRST ANTI EVER MADE) AND ITS ONE OF THE WORST PITITARY "ANTAGONIST" DEPAKOTE (2YEARS ON).

HOWEVER I WAS ON K FOR 8 YEARS. IN 2010 I HAD SIGNS OF ADRENAL FAILURE, I MEAN FAILURE. THAT WAS ALSO RIGHT AFTER I HAD INFECTIONS.

I AM G POO NG TO BE CONTINUING MY RESEARCH OF PITUITARY GLAND. THE DOCS LEFT ME HYPERCALCEMIC FOR 10 UEARS TO. HYPERPARA THYROISM (NOW CURED) THEY BEEN TRYING TO SAY IM HEALTHY NOW.

BRIGHTEN I GET IT AND ITS RELOVTING THEY BEEN AT THIS GAME SINE AMYTRIPTALINE CAME OUT IN THE 50s

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alo note they said i could simply stop taking it....so it ended up happening that way.....4 times. the mayo said they didnt know what to believe. i said well my grandma was treated here (she had it too until her death) so if u dont believe i (should have never been on k on the first place NEVER!!!!!!!!!-!!!

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what i am trying to find out if k usage interferes with atch test i had done in 2010. i thought i was having adrenal failure. funny thing is...ive been on a pill since....masking adrenal failure...slowing is down to only make it worse brightenn?

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  • 1 year later...
reachingforthestars

Could it be possible to lower your cortisol levels during taper by taking antidepressants earlier than usually? Like in the morning 2 hours before getting up? 

Citalopram 40mg from 2003-2015

Jan 2015 started tapering first dropped to 35mgFeb 30mg, March 25mgApril 20mg, May 17,5mg, June 15mgJuly 12,5mg, Aug 12,5mg,

Sep 0mg for 5 days because of stomac flu and after I raised to 7,5mg. All the symptoms of acute WD shaking, diarrhea, vomiting, barely could walk ect. Still didn't realize that it wasn't only stomac flu but I was also going through WD.

Oct 2,5mg and crashed again badly and quickly raised to 4mg. It was then when I knew my symptoms were due to WD.

Then in November after a month holding on 4mg raised to 5mg due to muscle weakness and had a VERY BAD reaction to reinstatement: akathisia(lasted for one or two weeks), insomnia, anhedonia... Drop quicly back to 4mg, Dec 3mg

Jan 2016 2,6mg( in the middle of Jan after I had been on 2,6mg for a week I tried to updose to 2,8mg and immediately had bad reaction to it: akathisia for a day, andehonia got worse. The next day dropped back to 2,6mg), Feb 2,4mg( a new symptom PGAD lasted 24/7 for 2 months after that on and off), March 2,4mg, April 2,3mg, May 2,2mg, June 2,1mg, July 2,0mg( Pgad almost nonexisting, sleeping pretty good, still some anhedonia but there has been a lot of gradual progress), Aug 1,97mg-1,89mg, Sep 1,88mg-1,49mg, Oct 1,48mg- 1,70mg,

Nov 0,65mg- current dose 0,5mg

 

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reachingforthestars

Does anyone know what happens to the cortisol levels after taking antidepressants? Does it increase or reduce immediately after absorbing? 

Citalopram 40mg from 2003-2015

Jan 2015 started tapering first dropped to 35mgFeb 30mg, March 25mgApril 20mg, May 17,5mg, June 15mgJuly 12,5mg, Aug 12,5mg,

Sep 0mg for 5 days because of stomac flu and after I raised to 7,5mg. All the symptoms of acute WD shaking, diarrhea, vomiting, barely could walk ect. Still didn't realize that it wasn't only stomac flu but I was also going through WD.

Oct 2,5mg and crashed again badly and quickly raised to 4mg. It was then when I knew my symptoms were due to WD.

Then in November after a month holding on 4mg raised to 5mg due to muscle weakness and had a VERY BAD reaction to reinstatement: akathisia(lasted for one or two weeks), insomnia, anhedonia... Drop quicly back to 4mg, Dec 3mg

Jan 2016 2,6mg( in the middle of Jan after I had been on 2,6mg for a week I tried to updose to 2,8mg and immediately had bad reaction to it: akathisia for a day, andehonia got worse. The next day dropped back to 2,6mg), Feb 2,4mg( a new symptom PGAD lasted 24/7 for 2 months after that on and off), March 2,4mg, April 2,3mg, May 2,2mg, June 2,1mg, July 2,0mg( Pgad almost nonexisting, sleeping pretty good, still some anhedonia but there has been a lot of gradual progress), Aug 1,97mg-1,89mg, Sep 1,88mg-1,49mg, Oct 1,48mg- 1,70mg,

Nov 0,65mg- current dose 0,5mg

 

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  • Moderator Emeritus

I'm not a doctor.  My comments are not medical advise. These are my opinions based on my own experience and what I've learned. Please discuss your situation with a medical practitioner who has knowledge of tapering and withdrawal...if you are lucky enough to find one.

My Introduction Thread

Full Drug and Withdrawal History

Brief Summary

Several SSRIs for 13 years starting 1997 (for mild to moderate partly situational anxiety) Xanax PRN ~ Various other drugs over the years for side effects

2 month 'taper' off Lexapro 2010

Short acute withdrawal, followed by 2 -3 months of improvement then delayed protracted withdrawal

DX ADHD followed by several years of stimulants and other drugs trying to manage increasing symptoms

Failed reinstatement of Lexapro and trial of Prozac (became suicidal)

May 2013 Found SA, learned about withdrawal, stopped taking drugs...healing begins.

Protracted withdrawal, with a very sensitized nervous system, slowly recovering as time passes

Supplements which have helped: Vitamin C, Magnesium, Taurine

Bad reactions: Many supplements but mostly fish oil and Vitamin D

June 2016 - Started daily juicing, mostly vegetables and lots of greens.

Aug 2016 - Oct 2016 Best window ever, felt almost completely recovered

Oct 2016 -Symptoms returned - bad days and less bad days.

April 2018 - No windows, but significant improvement, it feels like permanent full recovery is close.

VIDEO: Where did the chemical imbalance theory come from?



VIDEO: How are psychiatric diagnoses made?



VIDEO: Why do psychiatric drugs have withdrawal syndromes?



VIDEO: Can psychiatric drugs cause long-lasting negative effects?

VIDEO: Dr. Claire Weekes

 

 

 

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reachingforthestars

Thank you Petunia! :)

Citalopram 40mg from 2003-2015

Jan 2015 started tapering first dropped to 35mgFeb 30mg, March 25mgApril 20mg, May 17,5mg, June 15mgJuly 12,5mg, Aug 12,5mg,

Sep 0mg for 5 days because of stomac flu and after I raised to 7,5mg. All the symptoms of acute WD shaking, diarrhea, vomiting, barely could walk ect. Still didn't realize that it wasn't only stomac flu but I was also going through WD.

Oct 2,5mg and crashed again badly and quickly raised to 4mg. It was then when I knew my symptoms were due to WD.

Then in November after a month holding on 4mg raised to 5mg due to muscle weakness and had a VERY BAD reaction to reinstatement: akathisia(lasted for one or two weeks), insomnia, anhedonia... Drop quicly back to 4mg, Dec 3mg

Jan 2016 2,6mg( in the middle of Jan after I had been on 2,6mg for a week I tried to updose to 2,8mg and immediately had bad reaction to it: akathisia for a day, andehonia got worse. The next day dropped back to 2,6mg), Feb 2,4mg( a new symptom PGAD lasted 24/7 for 2 months after that on and off), March 2,4mg, April 2,3mg, May 2,2mg, June 2,1mg, July 2,0mg( Pgad almost nonexisting, sleeping pretty good, still some anhedonia but there has been a lot of gradual progress), Aug 1,97mg-1,89mg, Sep 1,88mg-1,49mg, Oct 1,48mg- 1,70mg,

Nov 0,65mg- current dose 0,5mg

 

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  • 2 weeks later...

Ann Blake Tracy goes into a great amount of detail about how SSRIs may affect hormone levels in her book, I would recommend giving that section of the book a read, I found it to be quite interesting.   In short, in this book she claims that SSRIs stimulate a massive cortisol release, which is why people experience mania, and boundless energy, etc.  I'm not sure how much biological evidence there is behind these claims, but it seems plausible based on my own experiences. 

 

http://www.amazon.com/Prozac-Panacea-Pandora-Antidepressants-Zoloft/dp/0916095592

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Interesting read. I used to wake up every morning like I was shot out of a cannon from cortisol.Off hand  I think it lasted 10 months and than completely went away and hasn't been back for 4 or more months. 

Was on 30mg (Lexapro) for 7-8yrs20mg for 3 months (This was my choice my Doc wanted me to drop much faster)15 mg 2week10mg 2 weeks 5 mg 1 week0 since August 24th . PPI Dexlant  30 mg taper has begun. Cutting 20% currently.  using zantac as needed.  Benzo is currently 0.10mg 

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  • 3 months later...
Rockingchaircat

I've been getting these damnable cortisol spikes for some time.  Originally they were the reason I got onto a Benzo (big mistake there). Now that many of the worst symptoms have gone into remission, the cortisol spikes seem to one of the most stalwart hanger ons.  

I don't seem to get them during a window. But only if I get up at the 'usual' bed rise time of 4 a.m. If I try to sleep in and enjoy a weekend- watch out!  When they originally occurred they were chest pounding painful. Nowadays they wake me up and I'm able get back to sleep in fairly short order.  Though of late they've been getting bad enough to make it difficult to breathe for about a half hour.  I've been trying to find a patter, but I cannot. I just want the damned things to leave me alone.

1)Zoloft- 6/99 to 8/04 2)Escitalopram- 8/04 to 8/10 3)Citalopram 8/10 to 4/14 (C/T), 4)Paxil a week or so, 5)Wellbutrin a week or so, 6)Reinstated Citalopram- 9/14 to 7/15

Before Taper- Celexa/20 mg....Taper Start- 04/21/15- 15mg....05/26/15- 10 mg...06/22/15- 5 mg...07/18/15- 0mg. http://tinyurl.com/qjfoqe9 Ativan/Lorazepam use/taper 10/14 to 2/15- http://tinyurl.com/ljebp84

Baclofen- Intermittent use of from 2008 till 2014. Some use of Promethazine. Some use of Zofran. Clobetasol Propionate- for Lichen Planus. Some Flexeril use. 

Ativan- GABA,A receptor Agonist., Baclofen- GABA,B receptor Agonist., Celexa/Lexapro- Serotonin 5-HT1A Receptor Agonist., Zofran- Serotonin 5-HT3 Receptor Agonist..Promethazine- Histamine H1-Receptor Antagonist. Flexeril- Serotonin 5HT2a Antagonist.

 

My self imposed Amino Acid Therapy: Tyrosine 500mg 1xday, Theanine 200 mg 1xday, & Taurine 500 mg 2x day. (All neurotransitter pre-cursors)- seems to have helped me immensely. And of course- eating healthy, including Black Beans for the oligosaccharides for gut health.

 

The attempt to develop a sense of humor and to see things in a humorous light is some kind of trick learned while mastering the Art of Living. - Viktor Frankl, Man's Search for Meaning.

 

 

 

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