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04/26/2012 05:11 PM

Psychiatric Issues

Posts: 8
New Member

Reposting this from the Addison's Disease forum.

This is a continuation of an old post with new questions. Here's the link to the history. discussions/general-support/3543310-is-my-nausea-due-to- hydrocortisone-withdrawal#3626720

My body goes into panic mode (nausea, quivers, light-headed; it feels like my body is shutting down) in all kinds of every-day situations, such as driving/riding in a car or airline, sitting in a restaurant or theater, etc. I recently had three doctor appointments and needed Xanax for two of them. This issue has gotten sporadically worse over the two years since my diagnosis.

A couple weeks ago, I got blood work, bone scans, and an MRI. Everything checked out as normal. My Endo (who is highly recommended by the local Addison's support group) said she saw no physiological explanation for my issues. I saw all the paperwork and confirmed everything was very normal. Even my cortisol level was in normal range, which is unusual because normally that test comes back very high.

It is possible, but unlikely, that there is a gastrointestinal problem; Endo did not test on that front.

She suggested psychiatric evaluation. Anyone else been seeing a psychiatrist or psychologist? Any info you have on this would be great. I do not exhibit any strange behavior or thoughts, but these physical symptoms may be caused by a psychological disorder of some kind - like anxiety disorder or panic.

Also, any recommendations for resources/approaches to this would be very appreciated.


04/27/2012 05:35 AM
Posts: 376

Hi silent child,

I have all of those symptoms as well when I go out places too. I was just diagnosed SAI and started hydrocortisone recently. But my doctor is testing for other concurrent causes of anxiety like high copper, low iodine and magnesium, and a genetic test for something people of Irish heritage can have that can cause anxiety and those kinds of symptoms. The doctor that finally ended up diagnosing and helping me after many other dead ends is a Functional Medicine doctor. He is a board certified family practitioner but certified in functional med. he looks at nutrition and whole body medicine. This approach has really helped me and made me feel like someone is listening and trying to get to the bottom it for me. He told me that I was sick and not to feel badly for my anxiety/depression, that they were symptoms of my illness and we would get me feeling better!

I totally understand those things you're going through! I know how bad it feels and how much it interferes with your life. I hope you are able to find a doctor to help you get to feeling better soon! Hang in there Smile

04/28/2012 12:52 PM
Posts: 479

My daughter experienced this when she tried to drive. Total bundle of nerves so bad she was shaking.

Our guess is that it could be a release of adrenaline. Sometimes our bodies don't have enough of one chemical so they 'compensate' by using another similar one.

If your body is low in cortisol compared to it's perceived need, it may release adrenaline, on the theory that it may help you handle the situation.

But adrenaline subbing for cortisol is like a rocket substituting for your car. Too fast, too powerful, more than you need and leaves you feeling like you just went though a horrible ordeal, worn out. Real cortisol would allow you to cope fairly calmly with the issue at hand and not become overexcited or nervous.

Just our theory, but it seems to make sense.

And when she got her steroids adjusted right, she no longer feels that shakiness and excess nerves. Fits the theory, at any rate. You won't find this in medical literature.

The other possible chemical your body can put out is norepinephrine, noradrenaline. It is a neurotransmitter that makes you alert, focused and increases your blood pressure to allow you to do the whole 'fight or flight' thing. But too much makes you feel overwrought, sorta like adrenaline but less intense and longer lasting.

They actually have norepinephrine and dopamine 'blocking' drugs that force your body to take it easy, but I doubt the psych doctors would consider them for less than a medical emergency like psychosis.

04/28/2012 02:03 PM
Posts: 42
New Member

My body goes into panic mode (nausea, quivers, light-headed; it feels like my body is shutting down) in all kinds of every-day situations, such as driving/riding in a car or airline, sitting in a restaurant or theater, etc. I recently had three doctor appointments and needed Xanax for two of them. This issue has gotten sporadically worse over the two years since my diagnosis.

A couple weeks ago, I got blood work, bone scans, and an MRI. Everything checked out as normal. My Endo (who is highly recommended by the local Addison's support group) said she saw no physiological explanation for my issues. I saw all the paperwork and confirmed everything was very normal. Even my cortisol level was in normal range, which is unusual because normally that test comes back very high.

Some of your problems could be related to the Xanax that you are taking. How often do you take it? Do you take it regularily? How much do you take and for how long have you been taking it? Many of the symptoms you mention are common for people who are in benzodiazepine tolerance. When I was in tolerance to a benzo I had many more symptoms that you listed & I told the many doctors and other medical experts I went to see the medications that I was on ....not one of them recognised the symptoms...All my tests came back normal. It was when I realised that my symptoms temporarily subsided when I took my pill that I realized that I was addicted.

If you are addicted, you don't need a psychiatric eveluation you need to slowly and carefully taper off the benzos.... there is a method to it. Never just stop taking them. Get proper advice from a forum....not a doctor or health worker because most do not know how to help you taper properly. You would probably need to cross over to a longer acting benzo -Xanax has quite a short half life to make the taper smoother. Don't go to a detox centre - they are worse - they usually CT a patient from the benzo and load them with more drugs - often equally addicted. Most people wind up an even bigger mess. Stevie Nix talks about her experience quite a bit.

Benzos alter your brain and body function because they cling to the GABA receptors in your brain and in your intestine which means your body cannot manufacture its own chemicals naturally. When you reach tolerance, your body wants more of the drug and the cycle begins.

Adrenaline like symptoms are common symptoms of benzo addiction - I had a lot of that which is why I am on this forum now.... recovering but I had other factors which affected my adrenals, like a messy divorce etc. Smile

04/28/2012 03:46 PM
Footprints11Posts: 396

Oh, Silentchild, {{hugs}} I read through these posts and try to contribute where I can, but there are posts every now and again that tug on my btdt heartstrings, and yours is one of them!

I may need to post more later, as it's almost time for dinner (and yeah, I should help, but wanna answer this first! lol) but for starters...yes, I understand! I, too, overreact to stressors to the point of shakes etc. If my life is calm, it takes large stressors to cause the shakes (currently I'm not working, and life is much easier that way!); if I have any stress in my life, the smallest thing will set me off. I like Waytoohandsome's description.

Fwiw, my "go-to" drug for both stopping the progression (will explain later) and as preventative (to stop it from happening) was xanax. The teensiest bit did the trick, and I only used it when necessary, so never worried about addiction. For the most part, hardly at all except for the semester that I taught a college level course. It was once a week (I got the three-hr marathon), so I took a xanax 15min before every class so I didn't get the shakes during class (or have nocturnal problems after...explain later). The ONLY reason I don't use it anymore is that my daytime problems were much worse two ys ago (jumbo jet level of lifestress); one time I needed it at night because I woke up with my warning symptoms, and it calmed me WAY TOO FAR down, to the point where it seemed like my heart was going to stop beating. I made my dh stay awake with me and made him promise to take a CPR course asap, that's how afraid I was. I think it had more to do with my body than the drug, though. background and its relevance.....9 ys ago, I had seizures in the middle of the night (status epilepticus, seizures all the way to the ER), and in the hospital my period started. A month later, on meds, I had nocturnal grand mal seizures (ie not as severe) right before my period; and the month later, same thing (nocturnal catamenial epilepsy, not that it matters). Neuro changed my med, and the seizures stopped, but sometimes (during times of daytime stress), I experienced these episodes (which I always considered breakthrough partial seizures because they happened at the same time of night and month as the grand mal seizures) where I would wake up with heart racing, flash of heat, building of head pressure/sometimes nausea, and then this all-over body shaking from my teeth to my toes. This is what I was given xanax to help with; and with daytime stressors, to take the edge off, so that these didn't happen at night.

BECAUSE the timing was so similar to my seizures, no docs ever mentioned the words "Panic Attack" to me. However, my MOM, otoh.....started having the same exact shaking spells around my age (mid 30s), even down to the middle of the night.....but she was told they were panic attacks, and treated not completely successfully for that. Only years later, after comparing notes, did she go see someone and to onto an anti-epilepsy drug (AED).

Next point...I don't have a detectable instability in my brain that causes seizures. Ie nothing obviously wrong with my brain. It's quite possible, I realize in hindsite, that the problem is chemical and that the seizures were secondary and not primary (if that makes sense). So if I'm asleep and my bp drops too low, or whatever, and my body says OMG SHOCK HER!!! And my body sends out adrenaline, maybe it overshot 9 ys ago (before I was on cortef for AI) and I seized. Now, I just get the shakes. Maybe. And, in fact, with the stress of the last few years, I am even MORE sensitive, and experience daytime episodes of all-over body shaking; it's no longer limited to night or my period.

Regarding anxiety.....remember, it's a chemical state as well as a mental state. We ALL experience stress and anxiety, but some of us physiologically handle it, whereas some of us physiologically "over-shoot". As I tried explaining to my mom, even *happy* states can set me off; it's not something I can control. that end...something I may re-consider is going on an anti-anxiety. The way one dysautonomia doc (a cardiologist, btw) explained it is the anti-anxiety med keeps us more *even* physiologically, so not high highs and not low lows.

Ooops, gotta go.....will be back later Smile

04/29/2012 06:09 AM
Posts: 1872
VIP Member

Hi Silentchild, and welcome to our forum. You will find lots of advice and support here. The symptoms you mention can definitely be caused by low cortisol. My symptoms do get worse when I travel - long ride in car or airline - and I almost always have to "bump up" my doseage and increase it to accommodate.

I do want to make one mention - xanax is a very potent drug and can have side effects on the nervous system. I am saying this because of a personal experience with two relatives - my mom was on xanax because of anxiety (she was going through cancer diagnosis) and the drug made her extremely weak and she trembled like a person with parkinson's. Of course since she was going through chemo that was the first suspicion - but when the doc took her off the xanax ALL of her symptoms went away even though she was still on the chemo. Then I had another family member on it - also had the shaky hands/limbs and actually slurring of words. This was a tighter correlation and we're sure it was the xanax. Xanax can also have effects that get worse when combined with other meds. So I would talk to a competent pharmacist PLUS your doctor about this.


04/30/2012 11:25 AM
Posts: 8
New Member

Thanks all for the input. I see a lot of talk about the Xanax, so I just wanted to clarify that the symptoms are NOT being caused by the Xanax. I had all these before I ever tried Xanax; in the last four months, I have only taken Xanax three or four times (and two of those were only half-a-pill): once for a get-together (which was the first time I ever took it), once for the Endo appointment, and once for the MRI. I didn't need it for the follow-up appointment with the Endo.

I took a whole pill for the first Endo apt and still felt miserable - almost like it didn't do anything for me. I describe Xanax as just barely taking the edge off, but it feels like a whole pill should be about 10 times stronger to really get the job done Smile. I now have a prescription for Xanax and Promethazine but haven't used any of them. I will only take them if absolutely necessary because I have to go somewhere and be functional (such as a Doctor apt).

Post edited by: silentchild, at: 04/30/2012 11:27 AM

04/30/2012 12:22 PM
Footprints11Posts: 396

Silentchild, that's how I understood your post to mean and, based on my own personal experience, I would agree that xanax is a good and effective way of preventing those episodes. I usually (except 1x) took a half-pill, too. I used them so rarely that they would expire before I'd use them up, but I felt better having a few on hand *just in case*. In short-if it wasn't clear above-I don't think of my episodes as "panic attacks"(nor has anyone ever called them that) because they happened in the same pattern as full-blown seizures. And on days that I DID experience a bad stressor (usually involving shaking etc), my nights were often worse (if it was "that time of month", DEFINITELY; which is why I started preventative dosing, or taking a teensie xanax before a major stressor like a presentation, so that I wouldn't experience the aftereffects that night). Something is off in my body causing them. The cardiologist who specializes in dysautonomia suggested an anti-anxiety pill in order to reduce the (physiologically-)exaggerated stress responses. Stressing the "physiological", not "mental". You can't not experience stress; we ALL do. But maybe the medication would reduce the over-reactivity. OTOH, a good endocrinologist might be able to help me figure the actual cause out, which would be really nice!

(I had been thinking about trying an anti-anxiety earlier this year but decided to go on progesterone instead for other problems;HUGE neg side effects including awful cardiac arrhythmias, scared the beejeebers out of me, so then I was afraid to try anything else new.....but I should go back and re-think the anti-anxiety)

Fwiw, I have secondary adrenal insufficiency ("SAI"Wink. You can always post your lab values here (ie test, result, and normal range per lab) to get better feedback.

05/02/2012 11:16 PM
Posts: 1817
Group Leader

I am sorry I have not responded before now. I had major psychiatric symptoms before diagnosis, most of which were categorized as high anxiety/panic attacks and panic disorder. Mumbo jumbo mumbo jumbo...lots of fancy words...I ended up on six xanex per day (no, not a typo), PLUS anti-depressants and various other drugs to try and get me back down to a normal and functioning level. I had been in therapy for years before, and I continued with it during all of this. My therapist worked with me on self-hypnosis and other coping strategies, but nothing seemed to help very much.

I was so anxious and panic-ridden, I worked and functioned fairly normally with all that xanex. On my decision, with my doctor's supervision, I weaned myself down from the xanex onto valium, gradually reduced my dose, and eventually weaned down to klonopin (getting less addictive all the time). Once I was diagnosed with AI and treatment started, I was able to drop my klonopin dose in half overnight, then I continued to wean down until I took only one per day in the evenings. I still have that prescription, but I only take one occasionally now.

That said to let you know - xanex exists for a reason, and some people obviously truly need it. Anyone who can not only function but have a successful career and raise a child on six xanex per day has a serious problem. Most doctors who hear about that now have a massive coronary at the thought, but at least SOMEONE was doing SOMETHING to help me, even if it wasn't exactly the right thing.

I completely agree with the assessment that when you don't have enough cortisol, the adrenaline kicks in. You get all of the symptoms of constant adrenaline rushes. Panic attacks. Yes. I would tell the doctor, hey, yes, I will gladly go see a therapist, but I would also like for us to look for other medical/physical reasons for this. I want to approach it from every imaginable angle, and let's see if we can't get it under control as soon as possible.

I have a hard time believing there isn't a physical root cause. That level of anxiety almost has to be something off in the body chemistry, in my non-medical opinion. But a good therapist is worth more than gold, and these days that's saying a lot. Just having a chronic condition can be anxiety-causing and depressing.



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