High ACTH & Depression, Addison's & Type I

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High ACTH & Depression, Addison's & Type I

Postby Steven » Sun Dec 16, 2012 6:38 am

Is there any evidence that persistently-high ACTH can contribute to depression, and if so any meds to help this beyond more steroids? IE is there a cause and effect relationship between high ACTH and depression? My college-age son has Addison's (05' diagnosis) and Type I (07' diagnosis), and has developed a very deep depression. His ACTH has consistently been over 1,500 and up close to 2000, and even with elevated steroid doses his ACTH has been around 1000. He takes 25 mg/day of Cortef and .01 mg/day of Flofinef.
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Re: High ACTH & Depression, Addison's & Type I

Postby gkardel » Sun Dec 16, 2012 5:37 pm

Hi Steven,

I haven't heard of any relationship between high ACTH and depression in Addisons patients. It's best to use symptoms to guide the cortisol replacement dose. If your son is fatigued then adjustment of the dose could help. Majority of the medical literature I've read state not to use ACTH level to guide cortisol replacement. Also, use the lowest dose that maintains patients well being. Even with cortisol replacement optimized with currently available meds, Addisons patients can still have elevated ACTH.

What time(s) and amount does your son take the 25mg daily dose of cortef?

Other thing to look at or keep your eye on is other endocrine conditions such as hypothyroidism as risk is increased with the conditions your son has. There's definitely an association with depression and hypothyroidism.

-Glenn
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Re: High ACTH & Depression, Addison's & Type I

Postby Steven » Mon Dec 17, 2012 6:05 am

Thanks very much Glenn. My son takes 25 mg/day of Cortef in three doses, assuming he is compliant and does not forget (10 mg AM, 10 mg mid-day, and 5 mg eve), plus 0.1 mg/day of Florinef. Thanks for the heads-up on hypothyroidism, which he has been screened for on a routine basis.
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Re: High ACTH & Depression, Addison's & Type I

Postby gkardel » Mon Dec 17, 2012 7:00 pm

Good to break up the cortef dose. Most do better on three or four times a day dosing. It's a challenge to match the normal production cycle of cortisol with the currently available med - this is part of the cause for elevated ACTH levels. Two new cortisol replacement meds, chronocort and duocort, are in developement. These meds are timed released with once a day dosing and should do a better job matching normal cortisol production. Here are some links:

http://www.diurnal.co.uk/products-pipeline/

http://www.duocort.com/index.php/therapy

-Glenn
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Re: High ACTH & Depression, Addison's & Type I

Postby gkardel » Tue Dec 18, 2012 9:11 am

...also wanted to mention symptoms to watch out for related to hypothyroidism: fatigue, weight gain, increased sensitivity to cold temperatures. -Glenn
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Re: High ACTH & Depression, Addison's & Type I

Postby Poly » Wed Jan 30, 2013 7:27 am

Steven,
I thought I'd add something just in case it helps your son. When I was diagnosed with Addison's and Hashimoto's thyroiditis (hypothyroidism) 40 years ago, I was put on an equal dose of cortisone every eight hours, meaning I took the same dose at bedtime that I took when I woke up, or attempted to wake up. Not until about 15 years later did an endocrinologist tell me that to more closely match the natural circadian rhythm of endogenous cortisol, I should be taking declining doses, with my last dose way before bedtime. My sleep was disturbed for years, and I wonder if there's any possibility that your son's last dose of the day could be too late and might be disturbing his sleep, which is depressing! Hypothyroidism is definitely something to strongly consider, as Glenn explained. Hope he begins to feel better soon.
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Re: High ACTH & Depression, Addison's & Type I

Postby Steven » Wed Jan 30, 2013 11:42 am

Thankyou -- my son often has trouble sleeping, has splitting headaches and feels lethargic. Various tests such as MRI's, Cat scans, EKGs, etc have been for the most part clear. He is going to be going through a procedure to help with depression, which is called ECT (Electroconvulsive therapy), and which has certain risks for a person with Type I and Addison's, so he will be doing so on an in-patient basis at a major university hospital. ECT is highly effective with older people (maybe 80%), but less so with younger people (maybe 50% to 60%).
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Re: High ACTH & Depression, Addison's & Type I

Postby Tinkermoose2 » Thu Feb 14, 2013 9:25 am

I honestly believe there is some correlation between high ACTH and depression and anxiety in Addison's patients. My husband has had primary Addison's disease since he was 13 years old. He is now 43. To make a long story short he has been battling anxiety and depression for more than 10 years. We didn't always know at the beginning that what it was but now in hindsight it is obvious.
My husband got cancer about 6 years ago and it was a tumor the doctors diregarded for 2 years. He ended up having Liposarcoma. Cancer of the Fat cells. It was during those 2 years that the srtuggle with anxiety and depression were obvious, but we did not ever associate it with Addison's. After the cancer was removed things just kep getting progressively worse. Fatigue was dibilitateing. He was a busy, hardworking provider up until then, but he just couldn't get out of bed. He finally conceeded to go to doctor to explore options. He started with Depression Meds. 3 different types. All made him worse. The primary care doctor suggested the Endo might help. His ACTH and Cortisol levels were checked and his ACTH was at 250. They thought it was nothing. Months went by and now he was mixing words, using them inappropriately. He was having what he calls Head Rushes and feeling like he wanted to pull his skin off. We then decided to go to Stanford. The Endo's in our area were stumped. By the time we got to Stanford his ACTH was 1250. He wasn't the same person. His personallity fluxuated between mellow almost too mellow to severe aggitation and sometimes even disorientation. Stanford was stumped too. They looked for Pituitary Tumors and found nothing. They filled him full of what ever pill they could through at him. Nothing was working and some were making him worse. It was on the suggestion of a Psychiatrist that we try to remove his stress so that the ACTH levels would naturally come down. ACTH being the "Flight or Fight "Hormone. That seem to do the trick. He moved into his own apartment. No kids , no job, no responsiblities. It wasn't easy but it took 6 months and he was starting to act like himself. We took him off all meds and that helped right away. Only 25mg Cortef. Now it has come back but is always directly related to some physical or emotional stresser. We are trying to help him journal now to find a pattern. Spacing the meds it one theroy. He wakes up in full panic attack. Next month we try waking up in the middle of the night to take cortef. Don't discount it. IT can change over night and it is hard to help them. I will attach medical journal articles I have found. Most of all DO NOT TAKE I DON"T KNOW FROM THE DOCTOR> IF THEY DON"T KNOW FIND SOMEONE WHO DOES> That was our biggest mistake. Misery for Him, Me and our 3 kids because doctors are lazy. Addison's disease is a 15 minute presentation in MED school and Endo's just don't have enough patients to justify their expertise. Find some one that is interested in finding the source not masking it with drugs. GOOD LUCK!!!
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Re: High ACTH & Depression, Addison's & Type I

Postby Abel » Thu Feb 28, 2013 10:51 am

It can be like because the over dosage of a medicine/supplement can cause different type of disease but the most important thing is mental relaxation.
Just stay mentally relax try not to worry much that can help you in getting rid of depression its actually all depends on brain.
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Re: High ACTH & Depression, Addison's & Type I

Postby clansing1 » Wed Aug 14, 2013 6:23 pm

Addison's, Type I, depression, sleep problems, etc....

I'm 41, had Type I Diabetes & Primary Addison's for 10 years, and Thyroid for 4 years.

I take the following:

.1-.2 Fludrocort daily
1.25 Mg Prednisone at bedtime
10 MG, 5 MG, 5 MG of HC at 7 AM , 11 AM, and 3 PM and as needed

50 MG of Levothyroxine Daily

Humalog and Lantus for the T1D

Before being diagnosed and treated for Addison's and T1D, I was being treated for severe depression. Too low or a lack of cortisol goes hand in hand with depression, in my opinion. I would recommend a small amount of prednisone to balance out the H. Cortisol that does not last as long as the prednisone. Your son might have plenty of HC during the day, but too little HC during the waking hours when your body is asking for it (5-7 AM). It is difficult to mirror the body's natural demand and need for cortisol. Taking a small amount of long lasting prednisone and short acting H. Cortisol for Addison's disease is sort of like taking a long acting insulin (Lantus) and a short acting insultin (Humalog) for diabetes.

It may be that the depression is a side affect of the lack of cortisol, blood sugars not in the proper range, and/or a combination of those 2 or another ailment. With multiple illness, if one or more is not treated effectively, the depression can be triggered as a sum effect of multiple diseases. It took me several years to get the Addison's treated aggressively and effectively. It is a dynamic process and it takes a while to learn the symptoms of Addison's disease (salt levels low, need for more cortisol, etc.).

It has been 7-8 years since I felt anything close to depression. I just learned what my limits are and what I can and can not do with the disease. Learning the symptoms and what to do treat it aggressively makes the disease manageable. I take a small amount of anti-depressant (7.5 MG) at bedtime that mainly puts me to sleep for the needed 8 hours. Anytime I 've tried to dose off of it leads to sleep problems.

Just my thoughts.

I hope this helps.

Chad
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Re: High ACTH & Depression, Addison's & Type I

Postby Steven » Tue Sep 24, 2013 6:31 pm

Thank you very much. Great input. My son who is now 21 is now taking Prednisone (7.5 mg/day) and Florinef (0.1 mg/day), but all in the AM. When he is compliant with the steroids, he does not exhibit signs of very much depression, but he is sometimes lax about compliance and pays the price. Can I possibly connect you and my son? Steve
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Re: High ACTH & Depression, Addison's & Type I

Postby gkardel » Wed Sep 25, 2013 9:08 am

Steven,

7.5 mg prednisone is a high dose and probably putting some stress your son's diabetes control. Prednisone impacts blood sugar more than cortef. 1mg pred = 4mg cortef so he's on a higher dose than he was on the cortef. Increased dose and stonger glucocorticoid = double whammy on the diabetes. Talk to his doctor about decreasing dose down to 5 mg. Also, morning dosing of prednisone doesn't do a very good job matching physiologic pattern of cortisol - this would be better with bedtime dosing.

I'm on a similar regimen to Chad's and he did a good job explaining the benefits of this approach for cortisol replacement. One issue for your son with this approach may be compliancy with four times a day dosing.

-Glenn
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