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Gianferante, 2014 Post-stress rumination predicts HPA axis responses to repeated acute stress.


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Psychoneuroendocrinology. 2014 Nov;49:244-52. doi: 10.1016/j.psyneuen.2014.07.021.

 

Post-stress rumination predicts HPA axis responses to repeated acute stress.

Gianferante D, Thoma MV, Hanlin L, Chen X, Breines JG, Zoccola PM, Rohleder N

 

Abstract: http://www.ncbi.nlm.nih.gov/pubmed/25127082

 

Abstract

Failure of the hypothalamus-pituitary-adrenal (HPA) axis to habituate to repeated stress exposure is related with adverse health outcomes, but our knowledge of predictors of non-habituation is limited. Rumination, defined as repetitive and unwanted past-centered negative thinking, is related with exaggerated HPA axis stress responses and poor health outcomes. The aim of this study was to test whether post-stress rumination was related with non-habituation of cortisol to repeated stress exposure. Twenty-seven participants (n=13 females) were exposed to the Trier Social Stress Test (TSST) twice on consecutive afternoons. Post-stress rumination was measured after the first TSST, and HPA axis responses were assessed by measuring salivary cortisol 1 min before, and 1, 10, 20, 60, and 120 min after both TSSTs. Stress exposure induced HPA axis activation on both days, and this activation showed habituation indicated by lower responses to the second TSST (F=3.7, p=0.015). Post-stress rumination after the first TSST was associated with greater cortisol reactivity after the initial stress test (r=0.45, p<0.05) and with increased cortisol responses to the second TSST (r=0.51, p<0.01), indicating non-habituation, independently of age, sex, depressive symptoms, perceived life stress, and trait rumination. In summary, results showed that rumination after stress predicted non-habituation of HPA axis responses. This finding implicates rumination as one possible mechanism mediating maladaptive stress response patterns, and it might also offer a pathway through which rumination might lead to negative health outcomes.

1988-2012: Prozac @ 60mg to treat an eating disorder. Several unsuccessful attempts to discontinue.Fall 2012: Failed attempt to discontinue then -> 40mg Prozac and added 150mg Wellbutrin. Late summer 2013:Began slower Prozac taper.Spring 2014:Got to 10mg Prozac, 75mg of Wellbutrin -April 2014: 9mg Prozac & 37.5mg Wellbutrin 2x/day -> 9mg Prozac & 25 mg Wellbutrin 2x/day->9mg Prozac 1x/day & ~8mg Wellbutrin 2x/day -> 8.1mg Prozac, 0 WellbutrinSept '14: 8.1mg Prozac -> crashed hardOct '14: 10mg ProzacNov '14: 20mg -> 30mgDec '14: 30mg, Feb 10: 27mg. Mar 7: 25mg Mar 21, 2015: 20mg. May 21, 2016: 20mg and holding strong. Taper restarted April 2021 to 18mg, July 2021 to 16mg, currently 15mg. 

 

My experience: http://rxisk.org/antidepressant-withdrawal-a-prozac-story/

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I posted this article's abstract because of the frequent reports of people ruminating during withdrawal. I think it's important to note that the HPA axis plays a role in ruminations.

1988-2012: Prozac @ 60mg to treat an eating disorder. Several unsuccessful attempts to discontinue.Fall 2012: Failed attempt to discontinue then -> 40mg Prozac and added 150mg Wellbutrin. Late summer 2013:Began slower Prozac taper.Spring 2014:Got to 10mg Prozac, 75mg of Wellbutrin -April 2014: 9mg Prozac & 37.5mg Wellbutrin 2x/day -> 9mg Prozac & 25 mg Wellbutrin 2x/day->9mg Prozac 1x/day & ~8mg Wellbutrin 2x/day -> 8.1mg Prozac, 0 WellbutrinSept '14: 8.1mg Prozac -> crashed hardOct '14: 10mg ProzacNov '14: 20mg -> 30mgDec '14: 30mg, Feb 10: 27mg. Mar 7: 25mg Mar 21, 2015: 20mg. May 21, 2016: 20mg and holding strong. Taper restarted April 2021 to 18mg, July 2021 to 16mg, currently 15mg. 

 

My experience: http://rxisk.org/antidepressant-withdrawal-a-prozac-story/

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 Thanks for this. This repetive negative/alarm  thinking is perhaps my most consistant WD syndrome.

In fact it has always been a bit of a problem for me.Learning a little about HPA axis from this site,

I feel sure it has to do with being stressed by chronic emotional abuse as a child.

On 20 mg of Prozac for about ten years. Sept 2012 started reducing 10% a drop using gram scale, with average of one month holds.

When I'd reached the half way mark, taking 10 mg  powder out of the 20 mg capsules, I switched over to 10 mg capsules and cutting

down from those. Withdrawals got harder the lower I dropped.  May 2013 changed to 5% drops, holding until all withdrawal symptoms gone.

January 2015 changed to liquid prozac (concentration of 20MG per 5 mL) using a 1mL oral syringe.

Current dose of fluoxetine solution equivalent 3.4 mg. Any effort to drop below this has been disastrous so for the time being I'm staying at this level.
Adding 200 mg Tryptophan and 200 GABA a day has helped with anxiety.
Also take 1,300mg Omega- 3,  875mg  Magnesium, 1800mg Curcumin, 1000mg Vit C, 5000 Vit D.
 

 

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I have noticed that when people describe the very horrible "deep, hellish depression unlike anything I have ever felt" during withdrawal, they say they are haunted by regrets, and swimming in memories of the worst of what happened since they lost control of themselves and everything else. I sure did. It was a hallmark of lying in bed at night and waking up in the morning, and it has a nice feedback loop with insomnia. I see it here and on other sites where akathisia - the inner torment aspect - during psychotropic withdrawal is experienced. It does seem like the basis is physical, because it is so common, and not a feature we recall having experienced before. It is also relentless and not subject to relief from and kind of rational analysis or perspective-taking.

 

Can you figure out if they nailed down the direction of causality in the rumination/ cortisol reactivity relationship? (Assuming they are the only factors at play (rather than a third factor that might influence both in the same direction? That is, something that causes increases or decreases in both measurements.)

 

Also, good job on seemingly formatting a journal post properly. You are an inspiration to us all.

2009: Cancer hospital said I had adjustment disorder because I thought they were doing it wrong. Their headshrinker prescribed Effexor, and my life set on a new course. I didn't know what was ahead, like a passenger on Disneyland's Matterhorn, smiling and waving as it climbs...clink, clink, clink.

2010: Post surgical accidental Effexor discontinuation by nurses, masked by intravenous Dilaudid. (The car is balanced at the top of the track.) I get home, pop a Vicodin, and ...

Whooosh...down, down, down, down, down...goes the trajectory of my life, up goes my mood and tendency to think everything is a good idea.
2012: After the bipolar jig was up, now a walking bag of unrelated symptoms, I went crazy on Daytrana (the Ritalin skin patch by Noven), because ADHD was a perfect fit for a bag of unrelated symptoms. I was prescribed Effexor for the nervousness of it, and things got neurological. An EEG showed enough activity to warrant an epilepsy diagnosis rather than non-epileptic ("psychogenic") seizures.

:o 2013-2014: Quit everything and got worse. I probably went through DAWS: dopamine agonist withdrawal syndrome. I drank to not feel, but I felt a lot: dread, fear, regret, grief: an utter sense of total loss of everything worth breathing about, for almost two years.

I was not suicidal but I wanted to be dead, at least dead to the experience of my own brain and body.

2015: I  began to recover after adding virgin coconut oil and organic grass-fed fed butter to a cup of instant coffee in the morning.

I did it hoping for mental acuity and better memory. After ten days of that, I was much better, mood-wise. Approximately neutral.

And, I experienced drowsiness. I could sleep. Not exactly happy, I did 30 days on Wellbutrin, because it had done me no harm in the past. 

I don't have the DAWS mood or state of mind. It never feel like doing anything if it means standing up.

In fact, I don't especially like moving. I'm a brain with a beanbag body.   :unsure:

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Alto's post on discontinuation research links to a trove or studies on the chemical/physiologic aspects.

 

http://survivingantidepressants.org/index.php?/topic/317-important-topics-in-journals-and-scientific-sources/

2009: Cancer hospital said I had adjustment disorder because I thought they were doing it wrong. Their headshrinker prescribed Effexor, and my life set on a new course. I didn't know what was ahead, like a passenger on Disneyland's Matterhorn, smiling and waving as it climbs...clink, clink, clink.

2010: Post surgical accidental Effexor discontinuation by nurses, masked by intravenous Dilaudid. (The car is balanced at the top of the track.) I get home, pop a Vicodin, and ...

Whooosh...down, down, down, down, down...goes the trajectory of my life, up goes my mood and tendency to think everything is a good idea.
2012: After the bipolar jig was up, now a walking bag of unrelated symptoms, I went crazy on Daytrana (the Ritalin skin patch by Noven), because ADHD was a perfect fit for a bag of unrelated symptoms. I was prescribed Effexor for the nervousness of it, and things got neurological. An EEG showed enough activity to warrant an epilepsy diagnosis rather than non-epileptic ("psychogenic") seizures.

:o 2013-2014: Quit everything and got worse. I probably went through DAWS: dopamine agonist withdrawal syndrome. I drank to not feel, but I felt a lot: dread, fear, regret, grief: an utter sense of total loss of everything worth breathing about, for almost two years.

I was not suicidal but I wanted to be dead, at least dead to the experience of my own brain and body.

2015: I  began to recover after adding virgin coconut oil and organic grass-fed fed butter to a cup of instant coffee in the morning.

I did it hoping for mental acuity and better memory. After ten days of that, I was much better, mood-wise. Approximately neutral.

And, I experienced drowsiness. I could sleep. Not exactly happy, I did 30 days on Wellbutrin, because it had done me no harm in the past. 

I don't have the DAWS mood or state of mind. It never feel like doing anything if it means standing up.

In fact, I don't especially like moving. I'm a brain with a beanbag body.   :unsure:

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This addresses that direction of causality problem, though regarding depression per se, not withdrawal.

 

http://www.madinamerica.com/2015/04/problematic-assumptions-slowed-depression-research/

 

"In Frontiers in Psychology, Belgian psychologist Eiko Fried argues for a different approach to understanding depression -- not as a discrete disease, but as a cluster of otherwise independent symptoms that trigger and reinforce each other."

2009: Cancer hospital said I had adjustment disorder because I thought they were doing it wrong. Their headshrinker prescribed Effexor, and my life set on a new course. I didn't know what was ahead, like a passenger on Disneyland's Matterhorn, smiling and waving as it climbs...clink, clink, clink.

2010: Post surgical accidental Effexor discontinuation by nurses, masked by intravenous Dilaudid. (The car is balanced at the top of the track.) I get home, pop a Vicodin, and ...

Whooosh...down, down, down, down, down...goes the trajectory of my life, up goes my mood and tendency to think everything is a good idea.
2012: After the bipolar jig was up, now a walking bag of unrelated symptoms, I went crazy on Daytrana (the Ritalin skin patch by Noven), because ADHD was a perfect fit for a bag of unrelated symptoms. I was prescribed Effexor for the nervousness of it, and things got neurological. An EEG showed enough activity to warrant an epilepsy diagnosis rather than non-epileptic ("psychogenic") seizures.

:o 2013-2014: Quit everything and got worse. I probably went through DAWS: dopamine agonist withdrawal syndrome. I drank to not feel, but I felt a lot: dread, fear, regret, grief: an utter sense of total loss of everything worth breathing about, for almost two years.

I was not suicidal but I wanted to be dead, at least dead to the experience of my own brain and body.

2015: I  began to recover after adding virgin coconut oil and organic grass-fed fed butter to a cup of instant coffee in the morning.

I did it hoping for mental acuity and better memory. After ten days of that, I was much better, mood-wise. Approximately neutral.

And, I experienced drowsiness. I could sleep. Not exactly happy, I did 30 days on Wellbutrin, because it had done me no harm in the past. 

I don't have the DAWS mood or state of mind. It never feel like doing anything if it means standing up.

In fact, I don't especially like moving. I'm a brain with a beanbag body.   :unsure:

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Off-topic posts hidden.

 

The HPA axis is involved in all body functions.

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

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Yes, indeed the HPA axis is involved in all body functions. I should have said, it's interesting to note the mechanism of action and WHAT role it plays, rather than simply mentioning it plays a role.

1988-2012: Prozac @ 60mg to treat an eating disorder. Several unsuccessful attempts to discontinue.Fall 2012: Failed attempt to discontinue then -> 40mg Prozac and added 150mg Wellbutrin. Late summer 2013:Began slower Prozac taper.Spring 2014:Got to 10mg Prozac, 75mg of Wellbutrin -April 2014: 9mg Prozac & 37.5mg Wellbutrin 2x/day -> 9mg Prozac & 25 mg Wellbutrin 2x/day->9mg Prozac 1x/day & ~8mg Wellbutrin 2x/day -> 8.1mg Prozac, 0 WellbutrinSept '14: 8.1mg Prozac -> crashed hardOct '14: 10mg ProzacNov '14: 20mg -> 30mgDec '14: 30mg, Feb 10: 27mg. Mar 7: 25mg Mar 21, 2015: 20mg. May 21, 2016: 20mg and holding strong. Taper restarted April 2021 to 18mg, July 2021 to 16mg, currently 15mg. 

 

My experience: http://rxisk.org/antidepressant-withdrawal-a-prozac-story/

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