The following question was posed by an attendee of our ARK webinar entitled, “Challenging Patients & Adrenal Assessment.” Our guest speaker for the webinar, Lena Edwards, MD, FAARM, has provided an answer, and we’d like to encourage you to share your experiences by commenting below.
If you haven’t viewed the webinar, you can link to it by clicking here.
Question:
During the last webinar, Dr Edwards made the statement “SSRIs, i.e. Celexa, Lexapro, Prozac can flatten cortisol levels.” My question is: Can you fix this flattening if the patient stays on the medication, or do you have to discontinue the med to get results?
Many of my patients who come in are on this class of medications from their other doctor.
Response:
Major depression has been intimately tied to chronic and excessive elevations of cortisol. Although SSRIs have the reputation of improving mood through their effects on Serotonin reuptake, it may actually be their ability to indirectly lower cortisol that explains their true efficacy.
SSRIs indirectly lower cortisol in several ways, all of which improve glucocorticoid (GC) receptor sensitivity:
- They increase GC receptor function and sensitivity
- They enhance endogenous GC negative feedback
- They reduce both resting and stimulated HPA axis activity
Now, one must keep in mind that SSRIs and other 'mood altering' medications have the propensity to also alter an individual's perception to a stressor – further affecting the cortisol release pattern.
If a patient is on a SSRI and has a flattened cortisol curve, it perhaps isn't necessary to discontinue the medication if the patient is symptomatically improved. However, it may be necessary to either reduce the dose or discontinue the medication.
An excellent article is available in the Journal of Psychoneuroendocrinology. Authors are Pariante CM, et al. 2004;29: 423-447. The title is "Do antidepressants regulate how cortisol affects the brain?"