13 ms·

In June some scientists in Australia published their paper that links an inability to produce cortisol to psychosis: https://www.jcu.edu.au/news/releases/2016/

by tcj_phx 10y ago

In June some scientists in Australia published their paper that links an inability to produce cortisol to psychosis: https://www.jcu.edu.au/news/releases/2016/june/stress-hormone-link-with-psychosis https://www.jcu.edu.au/news/releases/2016/june/stress-hormon... Cortisol is produced from Cholesterol (through a couple steps [1]). Cholesterol gets turned into pregnenolone in the mitochondria. My girlfriend did a lot of damage to her mitochondria with cocaine. 5 months after meeting me, she came to appreciate that "drugs" were causing her problems, and tried to quit everything cold turkey. Now she's getting professionally mistreated by Psychiatry. They are trying to suppress the symptom of "psychosis" without caring why it's being exhibited. [1] https://en.wikipedia.org/wiki/File:Steroidogenesis.svg https://en.wikipedia.org/wiki/File:Steroidogenesis.svg There is a ton of "technical debt" in the study of "mental disorders". Most of the research just needs to be thrown out. It would be much more productive to assume that people with mental problems are exhausted, give them cytomel (a T3 analogue), Retinol (Vitamin A), pregnenolone, and sugar, then re-evaluate.

DenisM 10y ago
Can you expand on your suggested treatments? Cytomel seems to be indicated for thyroid problems which are being routinely tested during psychiatry treatment.
- tcj_phx 10y ago
  There is a lot of technical debt in treating thyroid problems too. T4 needs to be converted to T3 to stimulate the metabolism; most of this conversion happens in the liver. If the patient's liver doesn't work very well (because she's damaged it with cocaine, for example), she can have normal a normal Thyroid Stimulating Hormone (TSH) level, and normal T4 thyroid levels, but still be hypothyroid. Cholesterol's conversion to pregnenolone requires T3-thyroid and Vitamin A (NOT 'beta carotene', which is a provitamin). By also supplementing Pregnenolone, and maybe progesterone, the patient has a better chance of being able to make Cortisol, if they need it. Also treating with sugar reduces the need for cortisol.
  - pasbesoin 10y ago
    Thank you very much for taking the time to write these comments. I have a friend in somewhat similar circumstances, though she does not appear to be manifesting overt psychosis. Nor do I have full insight into her treatment; however, the ongoing appointments are very infrequent. Hospitalization did give her 6 days with a very well regarded addiction specialist, and the ongoing medications as the result of his prescribing appear to be doing good. Among other things, she's become very consistent about getting good quantities of sleep. She's been a bit worried about her diet and weight gain. Some of the cravings, I now see as potentially lining up with your description. Maybe she can "let this go" for a while, while her body continues to recover and rebuild -- to the extent it can. Any opinion on exercise? She runs extensively, although some new soft tissue irritation is now potentially putting a multiple month crimp in this. That exercise is new in her life, as of a couple of years ago. I hope it is sparking her body's capacity to renew itself.
    - tcj_phx 10y ago
      > Thank you very much for taking the time to write these comments. You're welcome, thanks for the feedback. The only thing my girlfriend can do for herself while in the mental hospital is eat sugar for the stress response and caffeine-free coffee for the magnesium & Vitamin B1. The drugs they put her on are known to harm the metabolism, so she's put on a little weight, but sugar is a better source of calories than starch. As for exercise, I think weight-bearing exercise is much more helpful than cardio (which is very stressful). Muscle burns calories; endurance runners waste away. https://news.ycombinator.com/item?id=11589373 https://news.ycombinator.com/item?id=11589373
      - jsprogrammer 10y ago
        According to the USDA nutrient database, brewed coffee has no vitamin B1 and very little magnesium. Can she take a vitamin supplement? Ideally, all her nutrients would be gotten through daily food.
        tcj_phx 10y ago
simonster 10y ago
The claims you are making are stronger than the claims made by that paper (http://www.sciencedirect.com/science/article/pii/S0149763416300549 http://www.sciencedirect.com/science/article/pii/S0149763416...). First, the paper does not claim that cortisol production is related to psychosis. Instead, it measures the degree to which cortisol levels increase immediately upon awakening (cortisol awakening response or CAR), and specifically notes that CAR necessarily related to overall cortisol levels, but suggests that it may be related to hypothalamic-pituitary-adrenal axis function. It finds that CAR is blunted in patients with schizophrenia and first episode psychosis. However, it is not clear whether the changes in CAR are causal or symptomatic. For example, psychosis might lead to a disrupted wake-sleep cycle, which could then lead to blunted CAR. To determine whether there is a causal effect, you'd need to perform a longitudinal study, measuring CAR in patients who are at first normal but some of whom later go on to develop a psychosis, and show that the CAR differences predate the development of psychotic symptoms, instead of developing later. The paper notes that such longitudinal studies are "clearly needed." Mental illness is complicated. While it can clearly be explained scientifically, if the answer were easy, we would have found it by now. With that said, existing treatments have been shown to improve outcomes in double-blind placebo-controlled studies, even if we can't fully explain why, and that is why they are used. There are certainly problems with these treatments: They don't work for many patients and they often have undesirable side effects. But overall, we know that they help people, which is why we use them. There are undoubtedly better treatments out there, but either they haven't been discovered yet or they haven't been proven to help. There is no nefarious motive behind sticking to the status quo. Researchers know that, if they were to publish a paper showing spectacular results from a treatment with few side effects, it would be great for the people they're trying to help, and also for them and their career. Instead, people stick to the status quo because, historically, alternative treatments have not been as effective.
- tcj_phx 10y ago
  What is your motivation for defending the status quo? My goal for posting was to point out that existing mental health treatments don't work, and that there are promising developments that point to a better model. I didn't share all my references. > There are undoubtedly better treatments out there, but either they haven't been discovered yet or they haven't been proven to help. Antipsychotics have been shown again and again to be ineffective over the long term: http://www.madinamerica.com/wp-content/uploads/2016/07/The-Case-Against-Antipsychotics.pdf http://www.madinamerica.com/wp-content/uploads/2016/07/The-C... > There is no nefarious motive behind sticking to the status quo. Just inertia and institutional retardation.
omginternets 10y ago
>My girlfriend did a lot of damage to her mitochondria with cocaine. I'm familiar with the literature linking cocaine use to altered (often pathological) mitochondrial function. I wonder, though, how did you determine that your girlfriend had mitochondrial damage? Again, I understand that cocaine causes such damage, but my question pertains to how you evaluated her specific case.
- tcj_phx 10y ago
  > Again, I understand that cocaine causes such damage, but my question pertains to how you evaluated her specific case. She invited me into her world a little at a time. As the months went buy, I observed her buy and smoke a lot of crack cocaine. The first hospital told me they wouldn't let her go because they found cocaine in her bloodwork. At the time I didn't know about cocaine's effects on the mitochondria - that HN submission was 209 days ago [1]. [1] https://news.ycombinator.com/item?id=10956058 https://news.ycombinator.com/item?id=10956058 My evaluation is based on observation and inference. Her doctors don't care to check her mitochondrial function, but I'm sure there are appropriate lab tests.
  - omginternets 10y ago
    >My evaluation is based on observation and inference. Right, I'm asking what you observed.
    - tcj_phx 10y ago
      The main observation was "cocaine use". The inference was that this drug had damaged her mitochondria. She'd turn into an anorexic, and become more psychotic. I'd feed her, and she'd get better. It seems to me that she needs to eat more regularly than a normal person. I have a couple 'therapies' that help restore energy metabolism. Some of these obviously helped, but she was a difficult patient, and wouldn't use them regularly.
      - omginternets 10y ago
Gatsky 10y ago
Hey, sounds like a tough situation. HN probably isn't the place to be discussing this of course, but I just wanted to say that your girlfriend is lucky to have someone like you in her corner. I agree with you that something is a bit wrong with Psychiatry. It is in fact a very young field, and there is very little basic science or understanding behind the treatments. This is a frustrating and dire situation for patients suffering from severe mental illness.
- tcj_phx 10y ago
  Thanks for your supportive comment. I've learned a lot over the past year and a half... As I've said elsewhere, she was doing quite well until the system got its tentacles onto her, and I can't allow them to wreck her like they do everyone else. There is a lot of interest in mental health on HN... Sometimes I watch /newest, and come across submissions that provide clues for the puzzle. > I agree with you that something is a bit wrong with Psychiatry. It is in fact a very young field, and there is very little basic science or understanding behind the treatments. This is a frustrating and dire situation for patients suffering from severe mental illness. The field has been entirely corrupted by the drug industry, who used an incorrect interpretation of the findings science to sell their latest patent medicines. There are some good investigative journalism pieces in the Boston Globe in 2000 about the Prozac problem... It's especially telling that many of the 1st-generation anti-depressants were anti-serotonin drugs, while 2nd-generation "anti-depressants" are pro-serotonin drugs. There are some safe MAOI's, but these don't get used anymore because of "the cheese problem"... I think the proper use for an MAOI is for a week or two, to get someone out of bed long enough for them to start to take better care of themselves. Then the drug would be discontinued. I think Depo Provera (the 3-month "birth control" injection) turned my girlfriend into a drug addict, 10 years earlier... Provera doesn't do that to most people, but her history made her especially vulnerable to that particular drug.
MarkPNeyer 10y ago
Hey, just FYI - what you are doing can and does work. I had a drug addiction which I managed to kick with the help of the woman who is now my wife. Getting into a mess by yourself is easy, getting out is really hard. Thanks for doing this for her. Your intuition about the best testament being vitamins and sleep gibes with mine. We don't understand how consciousness and the brain work, but there is definitely something rotten in modern psychiatry. I think we need the notion of "mental injury" instead of mental illness. It's more like a broken leg than a tumor.
- tcj_phx 10y ago
  hi, thanks for your comment. > Getting into a mess by yourself is easy, getting out is really hard. This is well-said. > I think we need the notion of "mental injury" instead of mental illness. It's more like a broken leg than a tumor yes... uhm, let me think here. "mental illness" is used to imply that a person is defective... The term is basically contaminated. 'Mental injury' is moving in the right direction.

by tcj_phx 10y ago

DenisM 10y ago

Can you expand on your suggested treatments? Cytomel seems to be indicated for thyroid problems which are being routinely tested during psychiatry treatment.

tcj_phx 10y ago
There is a lot of technical debt in treating thyroid problems too. T4 needs to be converted to T3 to stimulate the metabolism; most of this conversion happens in the liver. If the patient's liver doesn't work very well (because she's damaged it with cocaine, for example), she can have normal a normal Thyroid Stimulating Hormone (TSH) level, and normal T4 thyroid levels, but still be hypothyroid. Cholesterol's conversion to pregnenolone requires T3-thyroid and Vitamin A (NOT 'beta carotene', which is a provitamin). By also supplementing Pregnenolone, and maybe progesterone, the patient has a better chance of being able to make Cortisol, if they need it. Also treating with sugar reduces the need for cortisol.
- pasbesoin 10y ago
  Thank you very much for taking the time to write these comments. I have a friend in somewhat similar circumstances, though she does not appear to be manifesting overt psychosis. Nor do I have full insight into her treatment; however, the ongoing appointments are very infrequent. Hospitalization did give her 6 days with a very well regarded addiction specialist, and the ongoing medications as the result of his prescribing appear to be doing good. Among other things, she's become very consistent about getting good quantities of sleep. She's been a bit worried about her diet and weight gain. Some of the cravings, I now see as potentially lining up with your description. Maybe she can "let this go" for a while, while her body continues to recover and rebuild -- to the extent it can. Any opinion on exercise? She runs extensively, although some new soft tissue irritation is now potentially putting a multiple month crimp in this. That exercise is new in her life, as of a couple of years ago. I hope it is sparking her body's capacity to renew itself.
  - tcj_phx 10y ago
    > Thank you very much for taking the time to write these comments. You're welcome, thanks for the feedback. The only thing my girlfriend can do for herself while in the mental hospital is eat sugar for the stress response and caffeine-free coffee for the magnesium & Vitamin B1. The drugs they put her on are known to harm the metabolism, so she's put on a little weight, but sugar is a better source of calories than starch. As for exercise, I think weight-bearing exercise is much more helpful than cardio (which is very stressful). Muscle burns calories; endurance runners waste away. https://news.ycombinator.com/item?id=11589373 https://news.ycombinator.com/item?id=11589373
    - jsprogrammer 10y ago
      According to the USDA nutrient database, brewed coffee has no vitamin B1 and very little magnesium. Can she take a vitamin supplement? Ideally, all her nutrients would be gotten through daily food.
      - tcj_phx 10y ago

simonster 10y ago

The claims you are making are stronger than the claims made by that paper (http://www.sciencedirect.com/science/article/pii/S0149763416300549 http://www.sciencedirect.com/science/article/pii/S0149763416...). First, the paper does not claim that cortisol production is related to psychosis. Instead, it measures the degree to which cortisol levels increase immediately upon awakening (cortisol awakening response or CAR), and specifically notes that CAR necessarily related to overall cortisol levels, but suggests that it may be related to hypothalamic-pituitary-adrenal axis function. It finds that CAR is blunted in patients with schizophrenia and first episode psychosis. However, it is not clear whether the changes in CAR are causal or symptomatic. For example, psychosis might lead to a disrupted wake-sleep cycle, which could then lead to blunted CAR. To determine whether there is a causal effect, you'd need to perform a longitudinal study, measuring CAR in patients who are at first normal but some of whom later go on to develop a psychosis, and show that the CAR differences predate the development of psychotic symptoms, instead of developing later. The paper notes that such longitudinal studies are "clearly needed." Mental illness is complicated. While it can clearly be explained scientifically, if the answer were easy, we would have found it by now. With that said, existing treatments have been shown to improve outcomes in double-blind placebo-controlled studies, even if we can't fully explain why, and that is why they are used. There are certainly problems with these treatments: They don't work for many patients and they often have undesirable side effects. But overall, we know that they help people, which is why we use them. There are undoubtedly better treatments out there, but either they haven't been discovered yet or they haven't been proven to help. There is no nefarious motive behind sticking to the status quo. Researchers know that, if they were to publish a paper showing spectacular results from a treatment with few side effects, it would be great for the people they're trying to help, and also for them and their career. Instead, people stick to the status quo because, historically, alternative treatments have not been as effective.

tcj_phx 10y ago
What is your motivation for defending the status quo? My goal for posting was to point out that existing mental health treatments don't work, and that there are promising developments that point to a better model. I didn't share all my references. > There are undoubtedly better treatments out there, but either they haven't been discovered yet or they haven't been proven to help. Antipsychotics have been shown again and again to be ineffective over the long term: http://www.madinamerica.com/wp-content/uploads/2016/07/The-Case-Against-Antipsychotics.pdf http://www.madinamerica.com/wp-content/uploads/2016/07/The-C... > There is no nefarious motive behind sticking to the status quo. Just inertia and institutional retardation.

omginternets 10y ago

>My girlfriend did a lot of damage to her mitochondria with cocaine. I'm familiar with the literature linking cocaine use to altered (often pathological) mitochondrial function. I wonder, though, how did you determine that your girlfriend had mitochondrial damage? Again, I understand that cocaine causes such damage, but my question pertains to how you evaluated her specific case.

tcj_phx 10y ago
> Again, I understand that cocaine causes such damage, but my question pertains to how you evaluated her specific case. She invited me into her world a little at a time. As the months went buy, I observed her buy and smoke a lot of crack cocaine. The first hospital told me they wouldn't let her go because they found cocaine in her bloodwork. At the time I didn't know about cocaine's effects on the mitochondria - that HN submission was 209 days ago [1]. [1] https://news.ycombinator.com/item?id=10956058 https://news.ycombinator.com/item?id=10956058 My evaluation is based on observation and inference. Her doctors don't care to check her mitochondrial function, but I'm sure there are appropriate lab tests.
- omginternets 10y ago
  >My evaluation is based on observation and inference. Right, I'm asking what you observed.
  - tcj_phx 10y ago
    The main observation was "cocaine use". The inference was that this drug had damaged her mitochondria. She'd turn into an anorexic, and become more psychotic. I'd feed her, and she'd get better. It seems to me that she needs to eat more regularly than a normal person. I have a couple 'therapies' that help restore energy metabolism. Some of these obviously helped, but she was a difficult patient, and wouldn't use them regularly.
    - omginternets 10y ago

Gatsky 10y ago

Hey, sounds like a tough situation. HN probably isn't the place to be discussing this of course, but I just wanted to say that your girlfriend is lucky to have someone like you in her corner. I agree with you that something is a bit wrong with Psychiatry. It is in fact a very young field, and there is very little basic science or understanding behind the treatments. This is a frustrating and dire situation for patients suffering from severe mental illness.

tcj_phx 10y ago
Thanks for your supportive comment. I've learned a lot over the past year and a half... As I've said elsewhere, she was doing quite well until the system got its tentacles onto her, and I can't allow them to wreck her like they do everyone else. There is a lot of interest in mental health on HN... Sometimes I watch /newest, and come across submissions that provide clues for the puzzle. > I agree with you that something is a bit wrong with Psychiatry. It is in fact a very young field, and there is very little basic science or understanding behind the treatments. This is a frustrating and dire situation for patients suffering from severe mental illness. The field has been entirely corrupted by the drug industry, who used an incorrect interpretation of the findings science to sell their latest patent medicines. There are some good investigative journalism pieces in the Boston Globe in 2000 about the Prozac problem... It's especially telling that many of the 1st-generation anti-depressants were anti-serotonin drugs, while 2nd-generation "anti-depressants" are pro-serotonin drugs. There are some safe MAOI's, but these don't get used anymore because of "the cheese problem"... I think the proper use for an MAOI is for a week or two, to get someone out of bed long enough for them to start to take better care of themselves. Then the drug would be discontinued. I think Depo Provera (the 3-month "birth control" injection) turned my girlfriend into a drug addict, 10 years earlier... Provera doesn't do that to most people, but her history made her especially vulnerable to that particular drug.

MarkPNeyer 10y ago

Hey, just FYI - what you are doing can and does work. I had a drug addiction which I managed to kick with the help of the woman who is now my wife. Getting into a mess by yourself is easy, getting out is really hard. Thanks for doing this for her. Your intuition about the best testament being vitamins and sleep gibes with mine. We don't understand how consciousness and the brain work, but there is definitely something rotten in modern psychiatry. I think we need the notion of "mental injury" instead of mental illness. It's more like a broken leg than a tumor.

tcj_phx 10y ago
hi, thanks for your comment. > Getting into a mess by yourself is easy, getting out is really hard. This is well-said. > I think we need the notion of "mental injury" instead of mental illness. It's more like a broken leg than a tumor yes... uhm, let me think here. "mental illness" is used to imply that a person is defective... The term is basically contaminated. 'Mental injury' is moving in the right direction.