BODY IN OVERDRIVE/ HIGH CORTISOL- Now using Remeron and Xanax

[Tjaloha]

Hi everyone- i am new here so I hope I am posting in the right area. I have some questions and need some advice. My pdoc is no good and doesnt help. here is a quick story of why I am here...
In october i felt run down and tired. Had my dr send me to an endo to see if i had adrenal fatigue. Endo did a saliva test for cortisol, and said i was fine, I thought it looked very low and posted on some facebook forums for adrenal issues and they all said it (my cortisol) was low too, that I should try these supplements I could buy on amazon called thryoid-s to kick my adrenals back up an give me more energy. I took them for just 10 days, and went in hyper mode... ended up in the ER the day after I stopped. This is when my nightmare began. I was shaking uncontollable, couldnt sleep, sweating-hot and cold- etc. Dr said I actually took thyroid pills and made myself hyperthyroid and it shoud go away soon. Well, it never went away. It got worse. Then I continued to not sleep, shake all the time, sweat, started getting dizzy and major brain fog, dry mough SO badly, constant ear ringing/ throbbing too, couldnt eat, diahrrea, though I had parkinsons. I think my adrenals crashed big time but dont know. My cortisol levels went throught the roof as shown via 24 hour urine tests, blood tests, etc. They tested me for cushings disease but i did not have that- went to drs all over the place....i wanted to die the symptoms were so bad and i could not do anything bc i was stuck in my head and so sick...had to take care of three small kids and a husband who doesnt get it-
They sent me to therapy and a psychiatrist becuase everyone thought i had anxiety. This was not just anxiety- but i couldnt convince anyone else it wasnt. SO I was forced by my family to take xanax and an antidepressant in december. I took zoloft for 2 days, just 25 mg, and ended up in the ER again, becuase of severe shaking, sweating, nausea, diahrrea that wouldnt stop- they said possible serotonin syndrome. So by the end of December I went on just xanax, .25- two to three times a day...but i didnt take it regularly until mid january. In early February they wanted me to try another antidepressant, which i was terrified to do bc of the last experience, and I read they all make your cortisol levels even higher- which i know is the main cause of my problems. I researched and found remeron (mirtazapine)- which is known to lower cortisol levels. I started remeron, and needed less xanax immeidately, I am now only taking 1/4 of a 0.25 xanax just once a day, and have even missed a day. My remeron is 7.5mg at night. I can sleep great on it. I feel clear headed finally, no more terror, still shake in the morning a little but I think that from high am cortisol... My body was in hyper drive from November 1- Feb 5 when the remeron slowed me down, and i could finally get out of my head after about 1 week on it. I dont now what happened to me- and I am still very afraid of it. I need to know- does Remeron act on gaba receptors like xanax? If I stop taking it will i go back to hyper drive? I am only taking 7.5 mg, which i heard only affects histamine receptors? I am now down to 1/4 of a 0.25 mg xanax a day, and want to get off that first...should I do every other day and then stop? I am very very sensitive to meds as well, and seem to notice every single symptom, etc...

 

[pasha]

Mirtazapine acts on serotonin, nor-epinephrine, dopamine, and histamine primarily but not GABA.

Your alprazolam taper is fine, stick to the 0.25 for a week or so and then stop.

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Let me understand, you had low cortisol levels when you saw a doctor, ordered pills, then your cortisol levels went through the roof, then the end result was you being placed on alprazolam (xanax) and mirtazapine (remeron).

If I may ask, if mirtazapine is effectively inhibiting (decreasing) cortisol secretion than why do you want to stop it? Insomnia and stress greatly increase cortisol levels as well, something which the mirtazapine is helping you with.

Do you think your hypercortisolism was a result of the pills you ordered online, and that now it has disappeared?

What does your doctor say at this point?

 

[Tjaloha]

Yes, you are correct- my cortisol was fairly low before starting the pills from amazon, and then i went hyperthyroid from them, and into panic mode, now my cortisol is high (a little more than double what the high end should be). Well, I just travelled to a new doctor in NYC March 7. He thinks the pills I took from Amazon made me hyperthyroid, but then that hyperthyroidism went away, but my anxiety continued due to that ordeal, then having no doctor that could help me made me worse, etc...I was VERY stressed and so physically ill, it was a vicious cycle. He ordered some tests and I am waiting to hear back from him to see where my cortisol levels are, and IF they have even lowered. I just guessed that they have lowered because 1. I am starting to feel alot better as of march and 2. the xanax i am taking now makes me feel "drugged" so i think (and my new dr thinks ) my body is healing and need less of it, which is why I am now taking 1/4 of my 0.25 xanax once per day for the past week. I think next week I could do every other day of the 1/4 xanax, then every third day? Or is this even necessary being such a low dose, and only using regularly since the end of December?
As far as the Remeron, I am not ready to stop it, and want to really recover before even attempting. I still have alot of symptoms, like ear ringing/ throbbing, shaking/ trembling arms in the morning...but NOTHING compared to where I was even a month ago. I guess I am afraid of the weaning off Remeron part, and fear the longer I am on it, the harder it will be to wean, but I obviously cant think about it right now and need to take the time to let the medicine help me first. I have read that Remeron at a low dose (7.5 that I am taking) does not hit the serotinin and other recepters, and only hits the h1 histamine receptor or something like that, and in higher doses it acts more as an antidepressant....is this correct? So basically am I just taking a very potent antihistamine using 7.5mg of Remeron? Thank you again for replying to me.

 

[pasha]

I have read that Remeron at a low dose (7.5 that I am taking) does not hit the serotinin and other recepters, and only hits the h1 histamine receptor or something like that, and in higher doses it acts more as an antidepressant....is this correct?

I've never come across such information before. I only know that a low dose mirtazapine is thought to be more sedating than a higher dose. Most people start mirtazapine at the 15 milligram dose and gain clinical benefit.

I'm glad you've chosen to stay on it as it can help you a lot with the alprazolam withdrawals. You should also realize that if you've dealt with the alprazolam withdrawals relatively easily, the mirtazapine withdrawals will be a piece of cake for you if you taper properly.

Personally though, if you're still exhibiting symptoms, which can perpetuate a cycle of stress followed by increased cortisol, you may want to evaluate if now is the right time for you to stop the alprazolam.

Don't you think you should wait for your symptoms to blow over and then quite the benzodiazepine?

 

[Venrak]

Don't you think you should wait for your symptoms to blow over and then quite the benzodiazepine?

That may be a good thing to discuss with your prescribing doctor. In this case, the benzo should be used as a stop-gap band-aid type of thing to minimize your symptoms while the real problem is being corrected.

 

[Swimmingdancer]

I have read that Remeron at a low dose (7.5 that I am taking) does not hit the serotinin and other recepters, and only hits the h1 histamine receptor or something like that, and in higher doses it acts more as an antidepressant....is this correct?

Pretty much. Mirtazepine has the highest affinity for histamine receptors, so in low doses it is mainly affecting them.

Spoiler: Long explanation

It's not an SSRI, it's considered a noradrenergic and specific serotonergic antidepressant. Unlike more conventional antidepressants, at doses normally used (even doses used as an antidepressant) mirtazapine has no appreciable affinity for serotonin, norepinephrine, or dopamine transporters and thus lacks any significant effects as a reuptake inhibitor of these neurotransmitters. Instead it antagonizes (blocks) the α2-adrenergic receptors and 5-HT2C (serotonin) receptors, which disinhibits dopamine and norepinephrine activity in these areas. Antagonization of the α2-adrenergic receptors enhances adrenergic and serotonergic neurotransmission in certain parts of the brain. Indirect α1-adrenoceptor-mediated enhancement of 5-HT (serotonin) cell firing and direct blockade of inhibitory α2-heteroreceptors located on 5-HT terminals are presumed responsible for the increase in extracellular serotonin. In addition, mirtazapine's blocking of the 5-HT2A and 5-HT2C serotonin receptors can help with anxiety and insomnia.

Receptors that could be blocked by a fairly low dose, in order:
H1 [histamine] receptor (Ki = 1.6 nM)
α2C-adrenergic receptor (Ki = 18 nM)
5-HT1A [serotonin] receptor (Ki = 18 nM)
α2A-adrenergic receptor (Ki = 20 nM)
D4 [dopamine] receptor (Ki = 25 nM)
5-HT2C [serotonin] receptor (Ki = 39 nM)

At the dose you are taking I would say it's probably only binding to the histamine receptor to a "clinically relevant" degree.

 

[Bluewaves]

Have you been able to get any relief? I think I am undergoing the exact same problem.