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General Medication Discussion This section is to be used for general medication discussion and other medications not broken out in their own respective forums.

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Old 11-11-13, 06:51 AM
JamieP23 JamieP23 is offline

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Stimulant Medication and Cortisol

Can someone please help me understand this.

A growing body of research suggests that people with ADHD have low cortisol levels. New research suggests that stimulant medication can increase these low cortisol levels.

Please see the following link for further information

My son has low cortisol and we are in the process of testing for Addison’s disease.

The research has got me thinking…..if people with ADHD have low cortisol, then –

How many of these people actually have either a primary or secondary adrenal sufficiency rather than ADHD?

Are either hydrocortisone or prednisone a treatment options for people with ‘ADHD’ who have low cortisol? I have read stories on the Internet where people with ADHD have been prescribed hydrocortisone or prednisone for conditions other than ADHD, but have noticed an improvement in their ADHD symptoms.

If stimulant medication increases cortisol levels, yet the levels are still lower than the general population, then can suddenly decreasing medication result in people going into an adrenal crisis??

Keen for people’s thoughts
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Old 11-11-13, 06:22 PM
Amun90 Amun90 is offline

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Re: Stimulant Medication and Cortisol

I have never tested my cortisol levels, but I actually suspect that they may be on the high end of the spectrum. Despite having no real stress in my social life and job, I still feel much more stressed since starting with psycho-stimulant medication compared to my previous state. Almost to the point of considering going off them.
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Old 11-11-13, 06:23 PM
dvdnvwls dvdnvwls is offline
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Re: Stimulant Medication and Cortisol

Didn't we just have this discussion the other day?
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Old 11-11-13, 08:49 PM
JamieP23 JamieP23 is offline

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Re: Stimulant Medication and Cortisol

Yes I posted something recently, but haven't had much of a response. I have since found new research on the issue, so wanted to post again.
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Old 04-22-14, 01:21 PM
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Re: Stimulant Medication and Cortisol

I came across your post while searching the internet on this subject.

I have a son who is 20 years old now and was diagnosed with inattentive type ADD years ago. We have tried many different things and nothing has really helped, however when he was 11 years old, he was prescribed prednisone for an allergic reaction to a bee sting and it was a miraculous difference. He was absolutely perfect ,no ADD symptoms whatsoever, and I could tell the exact minute that the prednisone was wearing off each day, all the symptoms just came right back. It was literally just like turning a light switch on and off.

I mentioned it to the doctor and all he said was, "well ,he can't be on that, it will melt his bones". So I searched the internet trying to figure out why it would have had that effect and if anyone else had that experience and I really couldn't find anything substantial and I finally just gave up.

Well, now that my son has a full time job and his ADD symptoms are hampering his ability at work, he went to a different doctor and I mentioned to that doctor about how miraculous the prednisone worked and he said probably because of the cortisol, but didn't offer any other info or help besides just prescribing Concerta, which did not help.

So that is when I started searching the internet for "cortisol, prednisone, ADHD" and have read that other people have noticed the same thing. I wish there was more info on what we could give him that would be like prednisone that would help him. It is heartbreaking to know that there is something out there that makes him totally symptom free, that would help him so much in his daily life, but he can't take it.

Last edited by namazu; 04-22-14 at 05:54 PM.. Reason: added some line breaks for easier reading
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Old 04-22-14, 10:47 PM
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Re: Stimulant Medication and Cortisol

Endocrine Dysfunction and Growth in Attention Deficit Hyperactivity Disorder

Is ADHD a Stress-Related Disorder? Why Meditation Can Help
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Old 05-12-14, 05:16 PM
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Re: Stimulant Medication and Cortisol

(Frequent lurker, rare poster)

I have inattentive type ADD (diagnosed 15ish years ago). I also have a genetic autoimmune disorder that lowers my cortisol levels and interferes with the way my body metabolizes and utilities the hormone. Never considered the connection!

Can't suggest anything to raise cortisol (my body can't use it correctly so raising it wouldn't help me), but if you really think there's a cortisol deficiency, I would suggest sending your son to an endocrinologist. Cortisol impacts the levels of many other hormones (estrogen, testosterone, renin, aldosterone) and there could be an imbalance that medications other than predisone might fix.

Another suggestion is to consider an autoimmune disease. High doses of prednisone suppress the immune system, and it could be that his ADD symptoms result from immune-modulated inflammation rather than actual ADD. Given that prednisone, but not stimulants, seem to work, this is something I'd look into. A rheumatologist would be the one to see for that.

Additionally, lots of people with autoimmune issues take prednisone daily, so it is possible, but it's definitely a drug where the risks can outweigh the benefits. An endo or rheumatologist would be much more knowledgeable and comfortable evaluating the risks than a regular doc.

My experience has taught me primary docs aren't always on the look out for those types of disorders. I spent 10 years accumulating a random assortment of strange diagnosises for a normal weight 20 year old (severe hypertension, crazy electrolyte abnormalities, migraines, frequent syncope, heart arrhythmias, seizures), none of which responded at all to traditional drugs. It wasn't until I ended up hospitalized by a cardiologist that sent and endo to see me as an inpatient that we finally figured things out.

Once we discovered the hormone imbalance and started medicating that and its effects instead of the symptoms, everything else disappeared (except the mental issues, ha). My disorder is super rare, and I don't mean to suggest your son has anything like it, but I guess my point is if you have decent insurance, it might be worth pursuing why predisone works and stimulants don't.
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Old 05-17-14, 10:32 AM
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Re: Stimulant Medication and Cortisol

Since beginning Stimulant medication I have noticed that my chronic dermatitis is not near as severe.
When I was in High School I noticed using heaps of Hydrocortisone cream helped me study better. I wish I had found Ritalin then. The steriods are bad. I would say stimulints are better.
Another doctor that may help is an immunologist
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Old 05-17-14, 04:38 PM
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Re: Stimulant Medication and Cortisol

I had a bad time with adrenal issues after I quit caffeine but was still using psychostimulant medication. In my case, supplementing with methylfolate - not folic acid - has gone a long way to reversing the problem. About 200mg of 5-MTHF dosed sublingually, 3-4x daily, does it for me.

Interestingly, the other methylation supplements don't do it for me, with sublingual methyl B12 making me notably tired and more lethargic. I think that a few grams of ascorbic acid powder per day also helps, but the effect is so subtle I'm fine just using the vitamin-C as an immune-system aid. It sure sucks trying to treat endocrine and other chronic conditions by one's self.
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Old 08-10-14, 07:57 PM
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Re: Stimulant Medication and Cortisol

I am finding some info on AD/HD and other cognitive/mood issues and autoimmune issues. PANDAS is considered a childhood autoimmune neurological disorder and some new evidence it can affect adults also. And that it might be giving ADHD to some people. http://beverlyhillsshrink.blogspot.c...are-facts.html One of the ways to test this is to use a fairly high dose of prednisone for 5 days to see if symptoms decline. The basic idea appears to be that this reduces the autoimmune response that can affect the brain and nervous system giving a slew of cognitive and mood issues. Strep infections appear often to be the root cause but other bacterial and viral infections can cause the same autoimmune response.

The cortisol and ADHD connection makes sense to me. Adrenaline, noradrenaline/norepinephrine, tyrosine, dopamine and cortisol share the same cascade pathway. Anything that creates a slow down or high demand for one of these biochemicals may deplete the others. One way I described this in another forum was through cooking and a limit in ingredients. Say you need to cook a meal for a large number of people. You want to make a quiche, muffins and custard and use eggs in all 3. But if you don't have enough eggs you can't make them all according to the recipe and something will be short. You can use all the eggs in the quiche and custard but the bread won't be the same. There are a number of reasons that you don't have enough eggs, the grocery store didn't get a delivery on time, you didn't have enough cash and forgot your check/debit card, or had plenty but used some for breakfast. There may be a number of reasons you are short on one of these biochemicals and your body has to try to put priorities on what goes where.

I got hit hard a couple of years ago with a virus that gave me bad long term fatigue. Low blood pressure, brain fog and also allergy type symptoms that may be mast cell activation or true allergies, have not yet don't allergy testing but both can be triggered by exposure to pollen or other thing but mast cells can be triggered by things that don't have an antibody response like changes in temperature. My mother would get bad attacks when going from AC car to hot humid air. She was given corticosteroid shots for years, did great for the symptoms and I don't recall her being depressed, anxious or neurotic at that time but it was a long time ago. The steroids eventually gave her bad effects as her damn doctor didn't keep up on the long term use. But remembering that a steroid helped her symptoms, I was so sick and debilitated and the prescription antihistamines did not help much. I tried a dose of prednisone left over from treating a dog with arthritis and in less than an hour I felt better than I had in weeks.

Had a saliva cortisol test done, wasn't rock bottom but was on the low side. More importantly I was symptomatic of low cortisol. Also having trouble with low blood sugar, cortisol is needed for glucose control. I tried low dose hydrocortisone 5 mgs, 4X daily and felt a huge relief. I'd been under extreme stress for several years and was coming out of it, life is good but my adrenals were possibly not able to give me all the cortisol. I had symptoms of MVPS, mitral valve prolapse syndrome that can be connected to POTS, postural orthostatic tachycardia, ie when I stood up my pulse raced as my blood pressure dropped too low and pulse tried to get blood to the brain. I also had bad reactions to insect bites at this time plus the runny nose and post nasal drip, watering eyes, cough, and my brain felt like a dimmer switch turned to low.

It turns out that a lot of POTS is triggered by a virus. And a lot of POTS'ies and MVPS'ers have some AD/HD symptoms. And that can tie in to problems with norepinephrine as that can affect blood pressure as well as brain function.

I also found that an herbal extract, Olive leaf extract, helped my energy and mental clarity. I had heard it helped with some fatigue and was antiviral. The first dose while waiting for my cortisol test to come back helped greatly, within an hour I felt a lot better. Not as good as the prednisone but better. Too fast to believe it was knocking out a lurking virus. I did a web search, had enough brain power to do so which was proof something was helping. Turns out it can raise NE. I've found that anything that raises NE, cortisol or adrenaline gives me a boost. But a burst of adrenaline at that time had a big price to pay with a crash.

I've had symptoms of AD/HD since childhood but wasn't dx'd until a few months ago at 58. My symptoms are on the low end but have waxed and waned through life. And enough to be a burden. I had done a lot of work in the past 2 years with checking out food sensitivities, balancing thyroid and sex hormones--all can be involved in the 'stealing of cortisol' and all improved symptoms but I'm still having enough problems I decided to try stimulants. The first dose of Ritalin proved something good was happening. But after a few days was giving me side effects that were not acceptable. Switched to Adderall and this was even better. But over the past few months, not quite as good as initially and not due to being habituated to it. I use some online head games to check reflexes, timing and such. This seems to be fairly common and perhaps cortisol is part of this.

The first doses may have taken the strain off my adrenals enough that I had a brief period of enough cortisol to control the autoimmune effects. But as time goes on, our bodies may downregulate production for various reasons. The cortisol as well as NE, Dopamine, and more. I had used the low dose hydrocortisone for some months and then tapered off hoping my adrenals could turn production back up. The reactions to pollen and insect bites have not been that severe again but I get some low grade signs of inflammation--joints swelling and occasional bad itching. And the last few days, have had some of this along with not feeling like the adderall has been quite as effective.

I may check with my doc and see about stopping the adderall for a few days and trying a prednisone challenge. If this helps, there are other things to consider for long term treatment other than prednisone. And from some of the info on the web, finding out if there is a hidden store of bacteria somewhere--tonsils and adenoids appear common places they lurk. But other things besides strep, other bacteria and viruses can cause the autoimmune problem.

But its possible that some autoimmune issue causes a high demand for cortisol and our bodies try to skimp on this 'egg' to make the norepinephrine and dopamine my brain needs. And that in turn affects my brain in a way that is due to the low cortisol not relieving the autoimmune problems. So a repeating cycle.

In part, I'm wondering if I may have had a trigger that is PANDAS related. In kindergarten, I had chicken pox, mumps and measles within a 3 week period. And sometime around that age, I had a period of what could be called a tic. I was blinking very hard at times, like squinting hard. And somewhere in that time period went from a fairly outgoing kid to anxious, very dependent on my mother, and other symptoms listed for PANDAS. With the way my symptoms of ADHD have waxed and waned throughout my life, the periods when I was most physically in peak form and perhaps producing the most cortisol may be a big part of this.

I've been a lifelong data junkie and book reader. I noticed that about 3 years back I was having trouble reading books. No longer able to sit down and read for hours but falling asleep or unable to recall what i just read. And other symptoms of ADHD worse. More trouble getting started on projects, even more disorganized and procrastinating even though much of my overall health had improved from the stress 7 years ago and my life is very good. I thought it was long term effects of the stress plus menopause and simply getting closer to 60.

I'm not feeling the way I think I SHOULD feel and that at times I still DO feel. Perhaps low cortisol is the root issue. I'll check into this and get back with results either way.
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Old 05-18-17, 12:36 PM
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Re: Stimulant Medication and Cortisol

This is very interesting.... Maybe that explains why I'm sooooooo productive and sooooooo driven and focused when I'm last minute: maybe the fact that I get under such pressure and stress that my cortisol rise to a functioning level? All beings have natural instinctive ways to know how to our body what it needs without actually being aware of it.....

In nursing school, my teachers noticed that working on the ER was the best for me.... 20 years later, I've stopped working in the ER, the stress was getting too high and I kept feeling an unbearable tightness in my chest, and my brain would go near blank trying to read a chart under pressure.....
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