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Kierkegaardian

My Anhedonia And Hormone Issues

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In the last two years I started suffering from what now looks to be a pretty significant low cortisol and hypothyroid condition.  The cortisol is almost certainly causing my thyroid to be more suppressed, given that cortisol is needed to get thyroid into cells, therefore low cortisol means low thyroid.  Dr. Jefferies refers to this in a breathtakingly good section in his book Safe Uses of Cortisol, where he mentions how people with insufficient (not even necessarily low) cortisol and either insufficient conversion of T4 (the mostly inactive thyroid hormone) to the active T3 (the engine of the thyroid that really does all the work) or inappropriately high levels of T3 because thyroid isn't being used by the cells and so is kicked back to the blood, giving the impression of normal thyroid status.

 

Well, I've had a moderate version of anhedonia in the last few years, and didn't notice it until I started getting my hormones straightened out.  Especially when I was lowering my thyroid dose I would notice the lack of pleasure -- reading and even watching movies or shows wouldn't be interesting, and I just distracted myself by playing on the Internet and doing easily distractable things that superficially kept my attention.  There were at least two week or so times in length when I had what would be called major depressive disorder had the symptoms remained for two weeks, which they didn't, all focusing around the symptom of anhedonia.  

 

In my case, though, even lowering my thyroid dose almost certainly negatively affected my cortisol -- both work interdependently together, so if one is off the other can be as well -- so it's somewhat doubtful that it was "just" my thyroid that was to blame.  

 

In related news, the STAR*D study, literally the biggest study on antidepressants yet done, showed that the most potent medication with the least side effects for people with depression was T3, the active thyroid hormone, and known by its medical name as triiodothyronine, brand name Cytomel.  

 

If you get your thyroid pulled, do not just trust doctors to tell you things are okay.  This is because doctors are trained in the false dogma of TSH worship, meaning they only look at a single hormone that actually isn't even a part of your thyroid but rather a part of your pituitary.  The real meat and potatoes of thyroid testing goes with free T4 and especially free T3, the latter hormone the one you really want to focus your attention on.  Even if it's in the middle of the range you might try and find a doctor who's willing to put you on a trial of Armour thyroid, which contains both T4 and T3.  Many patients have unsuccessful ventures with T4-only medications like levothyroxine, because they're not able to convert it properly to T3, meaning their brain picks up on a lot of T4 and so lowers TSH, even though the person might have lower T3 on this medication than before!  So get TSH, free T3, and free T4.

 

Now, just a bit of a word of warning here: you don't want to start T3, like me, when your cortisol is insufficient (i.e., insufficient adrenal reserve, where your body doesn't produce enough cortisol relative to ACTH stimulation, which happens all day long in relation to diurnal rhythm and is exacerbated, obviously, during stress), because that can make you feel worse.  It's possible to precipitate an Addisonian (i.e., very low cortisol) crisis by taking too much thyroid hormone.  So you absolutely must find a doctor who know a thing or two about cortisol, and is willing to pull ACTH and cortisol at the very least, and if possible also cortisol binding globulin, DHEA-S, and aldosterone (a minerocorticoid that is often down when cortisol is chronically down as well).  You can also take things into your own hand and get testing from the Life Extension site (buy the order online, print it off and take it to your nearest applicable lab), or go to canaryclub.com and order a 4x/day salivary cortisol test, and take it on a day when you're feeling least stressed.

 

There are answers out there.  One of the reasons, at least in my case, as to why anhedonia develops is high norepinephrine (which is typically raised with hypothyroidism) can lower dopamine, given that both hormones are in the same hormone line: tyrosine --> l-dopa --> dopamine --> norepinephrine --> epinephrine.  If your body has enough of a demand for norepinephrine, such as in the locus coeruleus in the brain (where the entire sympathetic nervous system response starts, with NE here triggering both NE and epinephrine in the adrenal medulla simultaneously with CRH, itself triggering ACTH, and ACTH triggering the adrenal cortex, including cortisol), it can lower dopamine.  

 

Dr Datis Kharrazian, in his new book Why Isn't My Brain Working?, spends a whole chapter on dopamine, including supplements you can take to increase it naturally.

Edited by Kierkegaardian

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Thanks for this post. It is very timely for my current situation. After four months of severe depressive/anhedonic symptoms, I recently visited an endocrinologist, to which it was discovered I have dangerously low levels of cortisol. Literally none. Addison's was originally suspected, however, I visited hospital recently, where my adrenals responded to the ACTH test, thus ruling themselves out as a the primary issue. It's unfortunately pointing towards a problem with the pituitary itself. I have taken hydrocortisone for 6 days without any noticeable improvements. My endocrinologist told me to stop taking it today and I'm going back for further tests soon. I am convinced that all my symptoms are related to the cortisol issue, though my endocrinologist believes it 'doesn't cause mood disturbance', despite there being seemingly reams of data and first person accounts online contradicting this. I really want to emphasise this point to him without denting his professional pride. I was extremely surprised he said this at all, being as he is a very respected endocrinologist and was aware of them term anhedonia. He's extremely professional and respected and has been in his field of work for 30+ years. Surely it's a given you are going to be unable to feel good when your body has been running on fumes for months and months?

Would it be possible to PM you with a question or two if need be? You're obviously very clued up on hormonal matters and at the moment it's all French to me!

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Thanks for this post. It is very timely for my current situation. After four months of severe depressive/anhedonic symptoms, I recently visited an endocrinologist, to which it was discovered I have dangerously low levels of cortisol. Literally none. Addison's was originally suspected, however, I visited hospital recently, where my adrenals responded to the ACTH test, thus ruling themselves out as a the primary issue. It's unfortunately pointing towards a problem with the pituitary itself. I have taken hydrocortisone for 6 days without any noticeable improvements. My endocrinologist told me to stop taking it today and I'm going back for further tests soon. I am convinced that all my symptoms are related to the cortisol issue, though my endocrinologist believes it 'doesn't cause mood disturbance', despite there being seemingly reams of data and first person accounts online contradicting this. I really want to emphasise this point to him without denting his professional pride. I was extremely surprised he said this at all, being as he is a very respected endocrinologist and was aware of them term anhedonia. He's extremely professional and respected and has been in his field of work for 30+ years. Surely it's a given you are going to be unable to feel good when your body has been running on fumes for months and months?

Would it be possible to PM you with a question or two if need be? You're obviously very clued up on hormonal matters and at the moment it's all French to me!

 

Your endocrinologist, respectfully, is wrong.  Low cortisol has been implicated in depression, and you can find a study or two on my thread on cortisol, e.g. this post on "hyperdrive" level of CRH (which is elevated in either primary or secondary adrenal insufficiency, and you sound like you might be secondary), or look at the next post I made that talks about low cortisol being associated with suicidal ideation, and at least 90% of people with suicidal ideation have depression, meaning low cortisol is indirectly at the very least linked to depression.  

 

Honestly, given his lack of research on the subject, his pride might deserve to be dented.  If you come to the forum I referenced above, you'll find *plenty* of "endo horror stories," and we're all still scratching our heads as to how endos can in general be so awful and downright ignorant with cortisol, thyroid, and testosterone-related conditions.  This is why I'd say the vast majority of guys who get appropriate cortisol or thyroid help do it through primary care MDs or even NDs and sometimes DCs (chiropractors) and other alternative docs.  

 

Second, and this is another thing supported by the research (albeit somewhat on the fringes given the popularity of medical dogma), the ACTH stimulation test can be insensitive and downright wrong, with many false negatives.  This is especially the case if you're looking at a secondary adrenal insufficieny situation, where (like you said) the problem is with your pituitary, which would mean low ACTH (which is released from the pituitary), and low ACTH would mean not just low cortisol, but all adrenal hormones given that ACTH stimulates pregnenolone, progesterone, DHEA, testosterone, estrogen, and cortisol (among others) all at once.  ACTH stimulation tests are least unreliable when it comes to measuring primary adrenal insufficiency, where cortisol is low but ACTH (in response to low cortisol via negative feedback) is high.  That's what I appear to be dealing with, but because my ACTH is high but in range, and same with low cortisol still in range, I really doubt I'd get a confirmation of adrenal insufficiency via the ACTH stimulation test and so would be cast on the street with a possible useless and even harmful antidepressant medication (I don't think antidepressant meds are generally harmful, quite the opposite, but if you put a person with low dopamine on an SSRI you can really screw this person up while he's on it, which is what happened to me when I tried fluoxetine/prozac for 6 days of hell) while my life went on crappily around me.  

 

Secondary AI means low cortisol because of low ACTH, which stimulates cortisol.  How much HC were you on?  Because unless you're supplementing with DHEA and possibly pregnenolone (MLM oral or transdermal forms), getting on HC when your ACTH is low is just going to suppress your ACTH even further, meaning you're getting even less pregnenolone, etc. stimulation (see this chart for an idea of what you're missing).  Dr. Mariano (whom I'd recommend flying out to Monterrey, CA to see if you have money for the flight and consultation, see his site at www.definitivemind) says that HC can actually make people feel worse because of too much ACTH suppression, because if ACTH is too low then other hormones like progesterone that are needed to make you feel good are squashed.  This can be overcome by getting on a good dose of pregnenolone and DHEA, both of which you can buy online or at a good vitamin store.  

 

Ok, so let's go a little further.  You have CRH, ACTH, and cortisol in the adrenals that constitute a basic negative feedback loop; also, CRH and norepinephrine in the brain are in a positive feedback loop, meaning CRH increases NE and NE increases CRH.  With secondary AI, your ACTH and therefore cortisol can be low, but often your CRH (which is in the hypothalamus and stimulates ACTH in the pituitary) is high, sometimes scary high.  Why?  Because of negative feedback: cortisol is low, so the hypothalamus picks up on this in the blood and says "ok, let's keep pumping out CRH until we reach the level of cortisol we need," which is going to be much, much slower if you have an adrenal problem, meaning CRH piles up in the blood, but because of whatever reason (brain trauma, enzyme problems, etc.) your pituitary doesn't release nearly enough ACTH despite CRH screaming at it full volume.  

 

Well, what happens with high CRH?  It increases NE in the brain, and NE in the brain travels immediately down to the inside of the adrenal glands, called the medulla, where it stimulates norepinephrine and epinephrine (adrenaline) in the blood.  This is why many people with adrenal problems have insomnia, anxiety, are very sensitive to stress (and stress takes a long time to "get out of their system"), and so on.  Their NE is often elevated because CRH is elevated.  Even though I'm primary adrenally insufficient, I still have the same effect even if my ACTH is high normal.

 

So it's possible that you just had too low of adrenal hormones because of low ACTH which was made even lower with HC, and/or your HC dose was too low or too high, among other possibilities.  What are your symptoms?

 

Remember this is all my opinion, and I'm not a medical practitioner.  

Edited by Kierkegaardian

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