One of the well explained phenomenon with cortisol administration is adverse psychiatric effects. Unfortunately, the euphoria observed with cortisol administration is seen by most as a benefit. It is not. Because it feels as if it relieves stress or depression is NOT a reason to take these drugs!
Further, cortisol administration, even in small doses used by those for “adrenal fatigue” cause memory deficits. These deficits can cause problems in work and everyday activities.
And do not be fooled by HAN all of a suddenly saying that “adrenal fatigue” is not the proper term, but use adrenal insufficiency. HAN’s knowledge of the adrenals is worthless. HAN does not know SHIT, which might speak more to his knowledge on the bowels.
Warrington TP, Bostwick JM. Psychiatric Adverse Effects of Corticosteroids. Mayo Clinic Proceedings 2006;81(10):1361-7.
Psychiatric adverse effects during systemic corticosteroid therapy are common. Two large meta-analyses found that severe reactions occurred in nearly 6% of patients, and mild to moderate reactions occurred in about 28%. Although disturbances of mood, cognition, sleep, and behavior as well as frank delirium or even psychosis are possible, the most common adverse effects of short-term corticosteroid therapy are euphoria and hypomania. Conversely, long-term therapy tends to induce depressive symptoms. Dosage is directly related to the incidence of adverse effects but is not related to the timing, severity, or duration of these effects. Neither the presence nor the absence of previous reactions predicts adverse responses to subsequent courses of corticosteroids. Corticosteroid-induced symptoms frequently present early in a treatment cycle and typically resolve with dosage reduction or discontinuation of corticosteroids. In severe cases or situations in which the dose cannot be reduced, antipsychotics or mood stabilizers may be required. This review offers an approach to identifying and managing corticosteroid-induced psychiatric syndromes based on the type of symptoms and anticipated duration of corticosteroid treatment.
Brown ES, Chandler PA. Mood and Cognitive Changes During Systemic Corticosteroid Therapy. Prim Care Companion J Clin Psychiatry 2001;3(1):17-21.
BACKGROUND: Physicians in the United States write approximately 10 million new prescriptions for oral corticosteroids each year. Common side effects of corticosteroids include weight gain, osteoporosis, and diabetes mellitus. This article reviews the available literature on psychiatric and cognitive changes during corticosteroid therapy.
METHOD: A search of the MEDLINE and psycINFO databases was conducted to find clinically relevant articles on psychiatric and cognitive side effects with corticosteroids using search terms including corticosteroid, prednisone, mania, depression, psychosis, mood, memory, and cognition.
RESULTS: Symptoms of hypomania, mania, depression, and psychosis occur during corticosteroid therapy as do cognitive changes, particularly deficits in verbal or declarative memory. Psychiatric symptoms appear to be dose-dependent and generally occur during the first few weeks of therapy. Patients who must remain on corticosteroids may benefit from pharmacotherapeutic approaches, such as lithium and the new antipsychotic medications.
CONCLUSION: Mood and cognitive changes with corticosteroids appear to be common but generally mild and reversible side effects. More studies are needed to determine effective treatment for steroid-induced psychiatric disorders.
Tollenaar MS, Elzinga BM, Spinhoven P, Everaerd W. Immediate and prolonged effects of cortisol, but not propranolol, on memory retrieval in healthy young men. Neurobiology of Learning and Memory 2009;91(1):23-31.
Background While acute cortisol administration has been found to impair retrieval of emotional memories in healthy subjects, the duration of this memory impairment is still unknown. Propranolol, on the other hand, may impair the reconsolidation of emotional memories during reactivation, although human studies examining such effects are scarce. The present investigation was therefore undertaken to examine the immediate and prolonged effects of a single administered dose of cortisol or propranolol on memory retrieval in a double-blind placebo controlled design.
Methods Eighty-five healthy male participants were asked to retrieve previously learned emotional and neutral information after ingestion of 35 mg cortisol, 80 mg propranolol or placebo. After a washout period of 1 week, recall was again tested.
Results Memory retrieval of neutral and emotional information was impaired by a single dose of cortisol compared to placebo. The memory impairment due to cortisol remained, even after a washout period of 1 week. No immediate or prolonged effects of propranolol on memory retrieval were found, despite significant reductions in sympathetic arousal.
Conclusions These results lend support to the hypothesis that cortisol is able to attenuate (emotional) memory recall in men over longer time spans and may therefore augment the treatment of disorders like post-traumatic stress disorder and phobias, but do not clarify the mechanism(s) through which propranolol exerts its therapeutic effects.
de Quervain DJF, Aerni A, Roozendaal B. Preventive Effect of {beta}-Adrenoceptor Blockade on Glucocorticoid-Induced Memory Retrieval Deficits. Am J Psychiatry 2007;164(6):967-9.
OBJECTIVE: Elevated glucocorticoid levels impair retrieval of emotional information, and animal studies indicate that this effect depends on concurrent emotional arousal-induced increases in noradrenergic transmission within the brain. The authors investigated whether the {beta}-adrenoceptor antagonist propranolol blocks glucocorticoid-induced memory retrieval impairments in human subjects.
METHOD: In a double-blind, placebo-controlled study, 42 healthy volunteers were presented a set of words with variable emotionality and asked to learn them for recall. A day later, cortisone (25 mg), propranolol (40 mg), or both drugs were administered orally 1 hour before a free-recall test.
RESULTS: Cortisone selectively impaired the recall of emotionally arousing words by 42%. This impairment was blocked by the concurrent administration of propranolol. Propranolol alone did not affect recall of either emotional or neutral words.
CONCLUSIONS: A pharmacological blockade of {beta}-adrenoceptors prevents glucocorticoid-induced memory retrieval deficits in human subjects. This finding may have important implications for the treatment of memory deficits in hypercortisolemic states, such as stress and depression.
de Quervain DJF, Roozendaal B, Nitsch RM, McGaugh JL, Hock C. Acute cortisone administration impairs retrieval of long-term declarative memory in humans. Nat Neurosci 2000;3(4):313-4.
I was actually interested in contacting Dr. Scally, after reading some of his posts, however this is a really irresponsible post - especially coming from a Doctor. In addition, from reading some of his responses to users, he clearly lacks bedside manner. I urge you to actually read the studies he has posted here, because what he posted above is very misleading.
1. The first report Dr. Scally references - Brown ES, Chandler PA. Mood and Cognitive Changes During Systemic Corticosteroid Therapy. Prim Care Companion J Clin Psychiatry 2001;3(1):17-21.
This report is about high doses of Prednisone in patients with issues like Asthma, COPD and other respiratory issues. It does not deal with low dose Hydrocortisone in patients with adrenal issues. The report only mentions Hydrocortisone
once, AND it references it in extremely high doses of 160MG/day. In fact it states that no adverse affects were noticed in a dose under 40MG/day. http://www.psychiatrist.com/pcc/pccpdf/v03n01/v03n0104.pdf
2. Tollenaar MS, Elzinga BM, Spinhoven P, Everaerd W. Immediate and prolonged effects of cortisol, but not propranolol, on memory retrieval in healthy young men. Neurobiology of Learning and Memory 2009;91(1):23-31.
Almost exactly the same thing as the first report. Deals with high dose Prednisone. http://www.medicine.wisc.edu/~williams/steroid_psych_effects.pdf
Keep in mind that the above two reports Dr. Scally references are not actual studies. They are peer reviews of studies already conducted. In fact, they both reference some of the exact same studies.
3. Tollenaar MS, Elzinga BM, Spinhoven P, Everaerd W. Immediate and prolonged effects of cortisol, but not propranolol, on memory retrieval in healthy young men. Neurobiology of Learning and Memory 2009;91(1):23-31
Although this is a valid study, there are several things to note here:
-Study was conducted on HEALTHY volunteers - not volunteers with low cortisol levels or suffering from adrenal issues.
-There were only 85 participants - hardly an exhaustive study
-They also do not state if they used a single does of 35mg/day or if they attempted to mimic the bodies natural production of cortisol by administering it 3-4 times/day.
You can read this study here
4. de Quervain DJF, Aerni A, Roozendaal B. Preventive Effect of {beta}-Adrenoceptor Blockade on Glucocorticoid-Induced Memory Retrieval Deficits. Am J Psychiatry 2007;164(6):967-9.
- Again, not related to people with adrenal issues
-42 volunteers of which 42% experienced impairment. That's almost 18 people. AND, it was in combination with the administration of propranolol.
It's absurd, irresponsible and upsetting that Dr. Scally would post this in regards to using low dose Hydrocortisone for people with adrenal issues. If you're going to cite reports and studies, they use ones that are relevant. None of these studies deal with people who have low cortisol levels. It's the same thing with Testosterone - if you have normal to high levels of Testosterone, you shouldn't be taking TRT - you may have some adverse affects. But if you're low T, then it works wonders. It's the same with many medications, vitamins, etc. There's a big difference in giving your body something it needs as opposed to having it in excess.
Take a simple vitamin - vitamin D. Someone who is deficient in Vitamin D, may need to take a high dose of Vitamin D to feel good, whereas that same dose taken by someone who already has a healthy amount of vitamin D, could cause Vitamin D toxicity.
Get your stuff straight Dr. Scally and stop misleading people.