PSYCHIATRY
Belgium, Brussels
March, 2014
~1~

Crying requires good Thyroid function

SNS stimulated by Thyroid, E2, Adrenaline, Dopamine

PNS stimulated by T, DHEA, Progesterone, Cortisol, GH

Low E2, high P…….PMS, fatigue, depression (note PMS may require E2)

PMS REQUIRES E2 and/or P

High E2, low P…….PMS, anxiety, nervous

PNS XS Cortisol Symptoms: swelling, weight gain, slow thinking

SNS XS Thyroid Symptoms: nervousness, hyperkinesis, insomnia

Lab values indicating low Cortisol:
Dec T4, dec RT3, dec T4/T3
Inc T3

Happiness requires Thyroid, 5-HTP, Oxytocin, Cortisol, E2, T, GH

Unhappiness caused by decreased Thyroid, 5-HTP, Oxytocin, Cortisol, E2, T, GH

Oxytocin def. Symptoms:
disturbed by others, shy withdrawn, introvert, cold personality, feel worse at social events

Melatonin def. Symptoms:
symptoms mainly at night (although GI produces low doses of daytime Melatonin)
anxious, difficulty getting or staying asleep
doesn’t awaken refreshed

Melatonin relaxes mind and reduces consciousness

5-HTP/Serotonin helps create satisfied mind, non-frustrated consciousness

Thyroid def. Symptoms:
AM depression, puffy face, swollen lower eyelids/hands/feet
in PM less swollen
PSYCHIATRY
Belgium, Brussels
March
~2~

T def Symptoms:
hesitation, lack of self-assurance, fatigue

E2 def and P def Symptoms:
low mood, lack of femininity

P def Symptoms:
superficial, nervous sleep

Sadness/crying caused by:
low Thyroid, increased Oxytocin, decreased 5-HTP, dec. sex hormones
So patient who can’t cry needs……Thyroid, Oxytocin, 5-HTP, sex hormones

Conversion of Tyrosine to Dopamine requires
Pyridoxyl 5-Phosphate and Vit C

Dopamine increases GH/Cortisol/DHEA/T/E2

Dec. Dopamine will increase pain in Parkinson’s, Fibromyalgia, Burning Mouth

Dopamine def Symptoms:
fatigue, increased pain, increased weight, loss of motivation, ADD

Deficiency of DA/ST/GABA will increase sweet food cravings

Dopamine def Tx:
L-Dopa 150 g (Mucina Pruriens: 125 L-Dopa) per tsp, 1 tsp AM and lunch for one month
then, 1 tsp AM
L-Tyrosine 500 mg with B6: 1-2 po AM and lunch for one month
Phenylalanine 500 mg: 1-2 AM, and lunch

Dopamine XS Symptoms:
decreased Prolactin and too quick erections, psychosis, nausea

Dopamine decreases Prolactin

Noradrenaline/Adrenaline mechanism of action: increased heart rate releasing glucose form energy stores, increases blood flow to skeletal muscles

PSYCHIATRY
Belgium, Brussels
March
~3~

Sxs of NA/A def:
dec BP, nasal stuffiness, anxiety, poor focus, poor attention span

ST def FRUSTRATION and weight gain
GABA def ANXIETY and weight gain
NA/A and Dopamine def FATIGUE and weight gain

Noradrenaline/Adrenaline def Tx:
L-Tyrosine and Pyridoxyl 5-Phosphate 500 mg: 2 po AM and lunch for one month, then 1 po AM and lunch
Copper 2 mg, Vit C 1000 mg, adrenal support

Noradrenaline/Adrenaline XS symptoms:
anxiety, mania, tachycardia, high BP

Histamine is an excitatory NT involved in allergy, inflammatory response, orgasm

Histidine (NT precursor to Histamine) def: undermethlation per ROEFM
allergies and leaky gut
lack of orgasm
lack of stomach acid

Histamine Tx for lack of orgasm in women:
Histidine 500 mg NPO: 2 AM, 1 before lunch, and 1 HS for two months, then
1 AM and HS
P5P (Pyridoxyl 5-Phosphate)

Inhibitory NTs: Serotonin and GABA

ST benefits: happiness bursts during day, dec anxiety and frustration, dec hunger esp for sugar/sweet craving, increases Melatonin
Good for last 4 hours of sleep

ST dec alcohol/sugar/sweet cravings, abdominal pain, hostile depression (and suicide), bulimia/alcoholism

ST def frustration, GABA def anxiety/depression, NA/A def low energy/depression

PSYCHIATRY
Belgium, Brussels
March
~4~

DA def manifests as fatigue and anger outbursts

ST def Tx for depression:
5-HTP 25 mg, 1 po AM, 1 po before lunch, 1-4 po HS
Tryptophan at 4 PM, and AA mix 1-2 gms NPO BID or TID

ST def Tx to decrease appetite:
5-HTP 25 mg 1 AM, 10-15 mg after B, 10-15 mg before lunch, 10-15 mg 4 PM, 10-15 mg before dinner, and 50 – 100 mg HS with Tryptophan

ST XS Sxs:
yawning, increased transient digestive disorder, disgust for food, nausea

GABA def Sxs:
clammy hands, tachycardia, feel stressed

Sleep disorders caused by ST def (awakenings/difficulty last 4 hrs of sleep)
GABA def can’t relax at night

Acetylcholine (Ach) is NT in peripheral and central nervous system

Acetylcholine requires B1, B5 500 mg, E and C 1000 mg to make co-enzyme A. Choline combines with co-enzyme A to synthesize Acetylcholine

Acetylcholine actions:
In PNS…..induces contraction of skeletal muscles (think shuffling, slow awkward gait) inhibits contraction in cardiac muscle fibers, increases sweating
In CNS….necessary for plasticity and arousal, enhances sustaining attention (implicated to play role in memory deficits associated with SDAT)

Acetylocholine def Tx:
Choline 300 mg 2 AM, 2 lunch, 2 supper for 4 months, then 2 AM and 1 supper
Phosphatidylcholine (for dementia only) 400 mg 2 AM, 2 lunch, 2 dinner for 4 months,
then 2 AM, 1 Supper
Lecithin 1200 mg 2 AM, 2 lunch, 2 supper
Pantothenate 500 mg 1 AM
Thiamine B1 50 mg 2 AM
B Complex 1 AM
E (mixed tocopherols containing alpha, beta, gamma, and delta tocopherols)
Vit C 1000 mg

PSYCHIATRY
Belgium, Brussels
March, 2014
~5~

Lecithin is rich in choline and often better tolerated than choline
Lecithin is precursor to Acetylcholine
Lecithin used for treating: dementia, anxiety, gallbladder disease, liver disease, eczema

Overmethylation (Histapenics per ROEFM) patients have too little Acetylcholine
Undermethylation (Histadelics have high absolute Basophils) patients have too much Acetylcholine

Phosphatidylcholine can worsen depression (if undermethylation says RFM according to my research done at Princeton Bio Center, 1995)

Phosphatidylcholine IV for fatty deposits in arteries, inject SC for lipomas

Acetylcholine XS Symptoms:
headache, tense muscles in jaw/neck/shoulder, irritability/depression, insomnia
etiology of headache, depression, and insomnia in Histadelics (undermethylators)

GABA Tx:
GABA 750 mg 1-2 AM NPO, 1 4 PM, 1 HS
Inositol 300 mg 2 AM, 2 lunch, 2 HS

Delicate balance between SNS hormones Thyroid, E2, E, NE and
PNS hormones Cortisol, Progesterone, Melatonin, GH, (Ach)

Reduce nervousness/irritability ~ Cortisol, Progesterone, and GH

Cortisol def. symptoms:
chronic fatigue, conjunctivitis, gastroenteritis, colitis, arthritis, joint pain, eczema, dermatitis, pigment spots on lips, dark undereye circles, frequent flu and infections, allergies, irritable with lack of energy, sugar cravings, increased catecholamines
(NA/A derived from adrenal medulla), hypochondriacal, outbursts of anger, negative, blaming, perfectionistic

With cortisol def. there is compensatory release of NE and E

Cortisol increases Dopamine

Catecholamines (DA,NE/E) are derived from adrenal medulla

Tyrosine coverts to L-Dopa converts to Dopamine

PSYCHIATRY
Belgium, Brussels
March, 2014
~6~

Postpartum thoughts of harming infant secondary to inc ACTH but no inc Cortisol secondary to adrenal weakness

Tricyclic antidepressants dec awakening Cortisol levels lending to perfectionism

Cortisol def Tx in women:
Mild 10/5 mg breakfast, 10 mg lunch
Moderate 15 mg breakfast, 10 mg lunch
Severe 20 mg breakfast, 10 mg lunch

Cortisol def Tx in men: men have 50% larger adrenal glands
Mild 20 (15)/10
Moderate 25 (20)/10 (5)
Severe 30/10 (5)
Stress/Sports + 50-150 %
Flu/Asthma +100-200%

Tx for acute stress is 5-10 mg/D of Hydrocortisone or 2.5 mg/D of Predni(sol)one

Overconsumption of Cortisol HS requires Melatonin so patient has enough AM Cortisol

25 mg Cortisone equal to 20 mg Hydrocortisone

Balance Cortisol with androgens esp. DHEA, E2, Melatonin, GH

Inhibits Cortisol:
Melatonin/GH/IGF-1/DHEA/E2/Oxytocin/MSH II/Vasopressin/E2, especially po E2

In the following order…..C, GH (0.1 mg = 0.3 IU), P, Melatonin, Magnesium (300-600 mg of elemental Magnesium AM, additional dose of 200 mg with stress, Serotonin (5-HTP) 25/10-15/10-15/10/50 HS, GABA 500 AM…………………… reduce anxiety and nervousness

Note that Potassium in fruit kicks out Magnesium

L-Tryptophan converts to 5-HTP and with B6 converts to Serotonin and 5HIAA

Melatonin decreases: Melatonin increases PNS
irritability, ST excitatory secretion in brain at night, NE/E, Dopamine (note Xyrem dec DA and NE), Glutamate, Cortisol

PSYCHIATRY
Belgium, Brussels
March, 2014
~7~

Melatonin increases:
number of receptors in cerebral cortex for benzodiazepines
Rx Melatonin with benzodiazepines = 1 + 1 = 3 to taper off benzodiazepines

Women with hysteria need Testosterone

Women with irritability need Testosterone

4 hormonal excesses that increase nervousness and irritability are Th/C/E2/T

Thyroid excess present as underactive anxious nervousness, seen in patients with low Cortisol and high caffeine intake which cause excess conversion of T4 to T3, patients have high T3…..Tx Cortisol and decrease caffeine

Cortisol excess present as overactive euphoric nervousness, Cortisol Tx presents as XS Cortisol when patient eats refined carbs…..Tx stop overeating carbs

Estrogen excess Sxs: negative, aggressively nervous, often premenstrual when Progesterone def. (E2 converts to less active E1 with Progesterone), or overtreatment with E2

Testosterone excess Sxs: overactive, dominant, afraid of nothing nervousness, irritable when frustrated, endogenous high Testosterone levels coverts to E2, or exogenous Testosterone Tx in presence of untreated GH def.

Melatonin XS Symptoms:
very deep and short sleep (3-4 hours)
excessively long deep sleep
intense dreams

Melatonin Tx:
0.1 – 1 mg SL 10 mins P/T HS
increase dose up to 2-6X if stressful day or jet lag
Mild def 0.05 mg SL, avg 0.2 mg SL
Moderate def 0.1-0.2 mg SL, avg 1 mg
Severe def 0.2-0.5 mg SL, avg 3 mg

Melatonin po poorly absorbed (inc dose 5X for po)
Mild def 0.3 mg PO
Moderate def 1.5 mg PO
Severe def 10 mg
PSYCHIATRY
Belgium, Brussels
March, 2014
~8~

Oxytocin deficiency presents as shyness, stressed by presence of others

Thyroid deficiency presents as wake-up depression

Cortisol deficiency presents as unable to handle stress, everything is too much

DHEA deficiency presents as feeling mild distress all day

Aldosterone deficiency presents as increased distress upon standing, and everything is too much

E2 Progesterone deficiency presents as distress during activities, including sexual

T deficiency presents as distress during physical activities, including sexual

Nutritional Txs to improve stress resistance:
Magnesium stops irritability, 200-800 mg elemental magnesium (Doctor’s Best Magnesium)
5-HTP removes frustration, 25 mg AM, 50 mg HS
GABA decreases anxiety and improves ability to relax, 750-1500 mg/D

PMS Tx w/ B6 (P5P 1-2 50 mg AM), Magnesium, possibly Progesterone

Hormones to increase stress resistance in order of importance are C, T, GH, Melatonin HS, Oxytocin

2 hormone Tx XS that worsen stress resistance are Th and E

Melatonin
Oxytocin
GH ALL REDUCE CORTISOL & WORSEN STRESS RESISTANCE
IGF-1
DHEA
Aldosterone

Hypochondria hormonal dysfunctions:
low Cortisol (hypochondria with suspicion)
low GH (hypochondria with anxiety and dramatizing)
low T
XS E2 in men
XS PTH
PSYCHIATRY
Belgium, Brussels
March, 2014
~9~

Burnout critical def. is Cortisol

Cortisol inc. Dopamine (Rx Cortisol w/ Adderall)

People who hate are low Cortisol

Burnout Tx with Thyroid:
Tx very slowly
Increase +15-30 mg or 5-20 ug T3 if intellectual challenge

Poor resistance to noise are DHEA def.

DHEA def. Sxs: fatigue, depression, anxiety, poor resistance to stress and noise

Treatments for anxiety in order of importance:
GH
E2 in women
Cortisol
Oxytocin
P especially for women
Melatonin

Other hormones that may reduce anxiety:
Thyroid
DHEA especially beneficial for women
E2 in women, and in men if low E2 (usually not on T Tx)

HRT for solitude and social withdrawal:
OXYTOCIN esp in ASD and Schizophrenia, O is the positive emotion hormone
GH
E2
T
Prolactin
Cortisol

Low Oxytocin and low Vasopressin (both produced by same neurons of posterior pituitary) both decrease ability to form social bonds, need Oxy for affectionate mind

PSYCHIATRY
Belgium, Brussels
March, 2014
~10~

Oxytocin may increase Vasopressin and cause edema in 1/3000 patients

Oxytocin may precipitously decrease Cortisol at dose of more than 5/IU

Oxytocin XS Sxs:
heavy head
low BP
overwhelming desire to have sex with partner
premature ejaculation
too quick orgasm in women
painful uterine, vaginal, anal contractions at orgasm
sticky, dependent behavior with partner
XSV dependence on compliments

People with adequately high Oxytocin need 8-10 hours of sleep

Serotonin dec Oxytocin…..hence etiology of difficult or impossible to climax

Oxytocin acts as anxiolytic and reduces amygdala action, activates neurons in central nucleus of amygdala (CeA)

Headaches and hormone Tx:
most headaches are caused by muscular contraction or blood flow problems
headaches may be triggered by head trauma, tumors, stress, dilated blood vessels,
muscular tension, low level of endorphins
sinus HAs caused by inflammation or congestion…pain behind brow bone and/or
cheekbones
cluster HAs are one sided, drooping of lid, with tearing….pain is in and around one eye
tension HAs are the most common HA, sensitivity (or lack of) sensitivity to pressure on
trigger points in upper trapezius, masseter, temporal, pterygoid and
sternocleidomastoid muscle…pain is like a band squeezing head
vascular HAs are migraines which constrict and open blood vessels…migraines result in
pain, nausea and visual changes

Thyroid relieves morning HAs
Estrogen relieves menstrual HAs
Progesterone relieves premenstrual HAs
Cortef/Prednisolone relieves stress/inflammation chronic sinusitis HAs
Melatonin relieves nighttime HAs
Desmopressin relieves dehydration HAs

PSYCHIATRY
Belgium, Brussels
March, 2014
~11~

Dexamethasone used for HAs and hirsutism

IV Dexamethasone decreases HAs more effectively than morphine

E2 Tx in menstrual period relieves premenstrual/beginning of menses HAs

Oestradiol patches in menstrual period only have slight effect on menstrual HAs

Progesterone decreases premenstrual brain edema HAs

Tension, sinus, and cluster HAs are facilitated by a Cortisol def.

Migraines are facilitated by a Thyroid and Estrogen def.

Headaches during the night are facilitated Melatonin def.

Melatonin def. may be due to a pineal gland cyst

Melatonin mechanism of action is antinociceptive (reduced sensitivity to painful stimuli) and stimulation of opioid receptors

Cluster HAs demonstrate decreased 24 hour serum Melatonin

HAs may be caused by Vasopressin deficiency

Decreased plasma Noradrenaline (NE) have HAs in fatigue conditions

Noradrenaline (NE) affects mood (Adderall inc. DA and NE) def Sxs stuffy nose and orthostatic Hypotension, Adrenaline (E) affects memory

NE requires B9 (Folic Acid) to convert to E(pinephrine)

Depression due to malfunction of NE pathways; i.e., high homocysteine (indicating def. of folic acid, B12, and B6) decreases production of catecholamines like NE/E/Dopamine

NE/E def. Sxs = stuffy nose, orthostatic hypotension

PSYCHIATRY
Belgium, Brussels
March, 2014
~12~

Major hormones for Tx of depression in order: 1) Sex hormones (E2/P/T), E2 acts as MAO-I to increase ST and brain opioids, 2) Thyroid stimulates cerebral blood flow, 3) GH, 4) Oxytocin, 5) Melatonin, 6) Cortisol, 7) DHEA (for women Tx w/ T/Thyroid/DHEA)

Oxytocin mechanism of action for depression ~ Oxytocin increases Beta endorphins

Primary Hypothyroidism: dec Free T4, inc TSH, inc. TSH response to TRH
Secondary hTH “subclinical”: normal Free T4, inc TSH, inc. TSH response to TRH
Tertiary Hypothyroidism: normal Free T4, normal TSH, inc. TSH response to TRH

Hypothyroid more prevalent in patients with refractory depression to antidepressant Rx

Definition of Sheehan Syndrome: much blood loss during childbirth…oxygen deprivation…pituitary damage, resulting in permanent underproduction of all pituitary hormones

Bipolar Rapid Cycling (4-50 episodes/year) have Thyroid deficiency

T3 25 mcg/D in combination with tricyclic antidepressants augment therapeutic response in patients who are euthyroid….suggesting an insufficient supply of T3 to brain of depressed patients

Tx of postpartum depression: Tx one month postpartum (or patient will bleed) with E2 TD 0.75 – 1.5 (2.25) mg/D on Days 1-25/27 of the month and Progesterone PO 100 mg/D on Days 1-25/27 of the month as needed

Bipolar Tx:
Thyroid first
E2 and P and T second
GH third

Neuroendocrine markers of melancholia: 1) failure of suppression of plasma Cortisol secretion in the DX-suppression test, 2) decreased TSH response to TRH, 3) decreased GH response to stimulating agents (Insulin, L-Dopa, amphetamines, IGF-1, and Clonidine increase GH)

Selegiline (increases Dopamine in Parkinson’s) and MAO-I anti-depressants like Meclobemide and Clorgyline increase Melatonin production

Melatonin good for night depression
PSYCHIATRY
Belgium, Brussels
March, 2014
~13~

Unipolar depression have lower intracellular lymphocytic Cortisol receptors, Rx Cortisol, and have dec NE (Th, E2, and P increase Catecholamines in women)

Cortisol paradox in depression is that there are high levels of Cortisol at night that keep patient awake, and poor response to stress (Cortisol should increase) during the day

In depression there is dysfunction of pituitary ACTH axis

Cortisol Mechanism of Action for Depression:
Inc levels of DA receptors in striatus (pleasure), hippocampus (emotions), gray matter
Inc Adrenaline receptors in cerebral cortex
Inc GABA receptors
“Possibly” activation of increased ST (Serotonin) receptors and less activation of HPA axis by ST receptors

Lab values indicating Cortisol def. are dec T4, dec Reverse T3, dec T4/T3, incr T3

Cortisol XS may result in euphoria/hypomania, Cortisol def. results in depression

Hormonal imbalances w/ Hypomania:
increased Cortisol, decreased Thyroid, decreased Melatonin

DHEA Tx for one month of 30-90 mg a day for middle-aged and elderly patients; studies show marked resolution of depression with 90 mg/D for six weeks; note that 3 weeks of 90 mg and 3 weeks of 450 mg did not improve outcome over 90 mg/D for six weeks

You will see increase of DHEA with resolution of depression

DHEA decreases neuroexcitatory Pregnenolone Sulphate

Morning depression requires Thyroid
Whole day depression requires T first, E2, and P
Overwhelming depression requires GH
Stress induced depression requires Cortisol

PSYCHIATRY
Belgium, Brussels
March, 2014
~14~

Impulsivity Hormonal Imbalances:
Cortisol def.
GH def.
T def.
P def. in women
E2 XS in women

Mood Swings and Emotional Lability Hormonal Dysfunctions:
Cortisol XS in men (reduce w/ Melatonin SL 0.1-0.2 HS, Oxytocin SL 5-15 IU/D, & GH)
GH def. (0.1-0.2 mg/D),T XS in men (reduce with Thyroid Rx, lower patient’s intake of meat), P def in women, E2 XS in women

Suicidal Ideation: Rx C AM, Rx Melatonin HS, GH calms continuous adrenaline surge, suicide attempt done during adrenaline surge

You will see inc. DHEA with resolution of depression

20 mg Cortisol, you need to Rx 20 mg of DHEA po (DHEA TD poorly absorbed)

Men need more DHEA – 50 mg., men’s adrenal glands are 50 % larger

Bipolar Rapid Cycling:
Thyroid – increased prevalence of hypothyroidism occurs with rapid cycling
70% improvement with Thyroid Rx
1/3 have antithyroid antibodies

Hypomania suggest disturbance in hormonal and NT levels:
increased Cortisol
decreased Thyroid
decreased Melatonin
decreased ACh
increased Catecholamines (DA, NE, E)
disturbance of Amino Acids

Hypomania Tx:
Thyroid Armour 30-180 mg.
Melatonin (reduces Cortisol) SL 0.05-0.5 mg HS
GH (reduces Cortisol) SC 0.1-0.3 mg
Tx to reduce Catecholamines
Tx to increase ACh
PSYCHIATRY
Belgium, Brussels
March, 2014
~15~

Tx with PNS stimulating hormones: GH, IGF-1 Progesterone, T, Melatonin
Note that Thyroid stims production of several PNS hormones

Bipolar II Depression:
prominent Sx of Bipolar II is depression, with displays of mania via irritation, agitation,
short fuse

Tx Bipolar II Depression:
Dessicated Thyroid, chew, 30-180 mg
Cortef 20mg w/ B and L for women, 30 mg w/ B and L men OR PREDNIS(OL)ONE OR METHYLPREDNISOLONE
EITHER CORTISOL OR PREDNISOLONE OR METHYLPREDNISOLONE
Prednis(ol)one 5 mg upon awakening
Methylprednisolone (Medrol) 4 mg/D
Melatonin SL 0.05-0.5 mg HS inc GH
GH SC 0.1-0.3 mg HS (Note: GH may precipitously lower Cortisol)
Estradiol TD 0.06% 1-3 grams Ds 1-25 AM
Progesterone 100-200 mg (for 11 to 15 days) HS
Testosterone gel 0.5% 1/3-1/2 gram AM for women, 10%1/2-3 grams AM for men

Bipolar Tx during Mania:
Thyroid
Melatonin to dec XS Cortisol
GH to dec XS Cortisol
5-HTP 25 mg upon awakening, possibly every 2 hours 10-15 mg, 50-100 mg HS
BEST HTP FROM SAFFRANE (helps sleep)
If patient is taking Seroquel which is ST antagonist, DO NOT Rx 5-HTP which is a ST agonist

Lithium Tx:
Lithium carbonate 300 mg HS, Thyroid AM (Lithium lowers Thyroid)

Lithium increases TSH and lowers Thyroid

Lithium decreases:
T4
Sex Hormones (Estradiol, Progesterone, DHEA, T, DHT)

PSYCHIATRY
Belgium, Brussels
March, 2014
~16~

Autism:
embryologically, pituitary glands begins to form in week 4

DECREASED IN AUTISM:
Melatonin
IGF-1
Oxytocin
Thyroid
Cortisol

INCREASED IN AUTISM (anabolic hormones):
Testosterone (Free and Total)
DHEA
DHT

Genetic disturbance of Oxytocin and Vasopressin Receptors in Autism

AUTISM Tx for deficiencies:
Oxytocin 1-3 IU/D
Armour Thyroid 7.5-120 mg/D OR Synthetic T4/T3
Cortef 2-3 mg TID (3 yo), 5-7 mg BID (8 yo) OR…Prednisolone 2.2.5 mg/D over 7 yo
Fludrocortisone 30-70 mcg/D
GH 0.05-0.10 mg/D
EPA 250 mg/D with DHA 500 mg/D

Endocrine disruptors definition:
MIMIC the effects of normal hormones by binding to receptors
BLOCK the effects of a hormone by blocking the binding of the hormone to the receptor
BLOCK synthesis of the hormone
DISTURB the effects by interfering with the hormone transport, or its elimination

PSYCHIATRY
Belgium, Brussels
March, 2014
~17~

SCHIZOPHRENIA ETIOLOGIES:

Prenatal famine decreases intracranial volume and decreases pituitary hormones
Deficiency of Oxytocin and/or Oxytocin receptors perinatally
Inc. Homocysteine may precipitate Schizophrenia
Exposure to genital/reproductive infections perinatally may precipitate Schizophrenia
Inc. Lead may precipitate Schizophrenia
H/O autoimmune disorders
late winter birth
small for gestational age
bleeding during pregnancy
DYSFUNCTION OF HPA AXIS

DECREASED IN SCHIZOPHRENIA:
Estradiol
Progesterone
Oxytocin (insensitive Oxytocin receptors)
Thyroid
T
GH
Melatonin (note that children require higher doses)
DHEA (w/ increased C/DHEA ratio)
Cortisol (inc. ACTH but unresponsive to stim w/ result of dec. Cortisol) – ALSO NOTE THAT IT IS MORE DIFFICULT TO SUPPRESS ADRENALS IN CHILDREN

INCREASED IN SCHIZOPHRENIA:
Lead
Homocysteine
Prolactin
increased ACTH – unresponsive to stimulation with resultant decreased Cortisol

PSYCHIATRY
Belgium, Brussels
March, 2014
~18~

Schizophrenia Tx for deficiencies:
Oxytocin 10/IU in AM
GH 0.10-0.50 mg/D
Thyroid Armour 45-210 mg/D or Synthetic T4 and T3 (neuroleptics dec. Thyroid)
Cortisol 15-30 mg for women, and 25-40 mg for men (neuroloeptics dec. Cortisol)
Aldosterone (Fludrocortisone) 100-150 mcg/D
Testosterone for women TD 2-5 mg/D
Testosterone for men TD 75-200 mg/D or IM 100-150 mg/week
Estrogen TD E2 1.5-4 mg/D for women- prem. Ds 5-25, postmenopausal 1-25
Progesterone 50-100 mg for women – premenopausal Ds 5-25, postmenopausal 1-25

Neuroleptics decrease Thyroid and decrease Cortisol

Acute Psychosis Deficiencies: dec T4, dec. T3, dec Free T4, dec T

DHEA and Estradiol decrease positive, negative, and extrapyrimidal Sxs of schizophrenia

Miscarriages may be secondary to Mercury intoxication in uterus

Estradiol and Progesterone decrease positive and negative Sxs of Schiz in women

Testosterone decreases schizophrenia symptoms in men

Addison’s Disease Sxs:
apathy, negativism, quarrelsomeness, irritability, depression, psychosis
rarely psychosis with paranoid trends

Paranoia hormonal deficiencies:
Cortisol (see Addison’s Disease Sxs above) 15-35 mg/D or Prednis(ol)one 5 mg/D
Low adrenal hormones…..Cortisol, DHEA, Progesterone, etc.
DHEA 15-50 mg/D
Aldosterone (Fludrocortisone) 0.1 mg/D
Oxytocin (anxiolytic (calms anxiety) by activating neurons in central nucleus of amydala) Oxytocin 5 IU AM and 5 IU HS
GH 0.1-0.25 mg/D
LOW or HIGH Testosterone levels

PSYCHIATRY
Belgium, Brussels
March, 2014
~19~

Sexual arousal in women:
oophorectomized women lose 80% of Testosterone during surgery, Rx T TD10 mg
always provide E2 and Progesterone with androgens to prevent virilization
E2 and Testosterone increase libido, but E2 requires T to work
Bremelanotide and Melanotan II (MSH) increases sexuality, 0.1 to 0.3 mg/week – 0.05 to 0.15 2X wk
DHEA 10-30 mg for women and 50 mg for men
Oxytocin 5 IU AM and HS

Rx Resistant Cases of loss of sexual arousal in women:
T SC 20 mg q other week to max. of 80 mg/month
DHT 2.5% (Andractim) cream applied to clitoral hood

Sexual arousal in men:
TD T gel 0.5 — 1/2 to 1 gram/D — 2.5-5 mg/D
Melanotan II 0.1 mg 3X week
DHEA 50 mg
Oxytocin 5 to max at IU/D AM and HS (sublingual)

Cyproterone acetate blocks the peripheral action of DHT…..dec mounting and intromission frequencies block ejaculatory behavior, dec DHT stimulated seminal vesicle and penile weight lengths

Sexual desire in men is influenced (and possibly even more by its direct metabolite E2 in men) – low Estradiol in men loss of sexual desire

Buy book Best Erotic Fantasies by Harold Litten

Top 6 hormones to improve Dementia, Alzheimer’s Type:

Thyroid Tx improves brain blood flow, provides oxygen, nutrients and water to brain to cells, reduces progression of atherosclerosis, improves memory
Pregnenolone min 100 mg in AM
Estrogen and Progesteorne
Testosterone improves memory
GH repairs nerves, slows down brain and neuronal deterioration, improves memory
Vasopressin/Desmopressin improves water content of brain and improves memory

PSYCHIATRY
Belgium, Brussels
March, 2014
~20~

Too high or too low TSH increases risk of Alzheimer’s

Patients with Parkinson’s and Alzheimer’s have dec. Estradiol and dec. BDNF

High Estrogen levels are risk factor for development of MS

GH, Cortisol and Melatonin permits patients to remain at home longer

Sleep disorders:
Melatonin
GH deepens and prolongs sleep Stage 3 & 4, REM sleep (which is Stage 5), and
reduces Stage 1 & 2 superficial sleep
IGF-1 produces longer and deeper sleep
Oxytocin
Thyroid prolongs Stage 3 & 4 sleep…..and reduces sleep apnea snoring
XS THYROID CAUSES TACHYCARDIA, CARDIAC ERETHISM (ABNORMAL
CARDIAC RHYTHMS), PREVENTS FALLING ASLEEP, AND REDUCES STAGE
3 & 4 SLEEP
If patient has abnormally high evening and bedtime Cortisol causes insomnia
If patient requires Cortisol at night…..5 mg Cortef HS prevents nighttime eating
DHEA at high doses prolongs REM Stage 5 sleep
Estrogen prolongs Stage 3 & 4 sleep — E2 gel 1-4 g of 0.6 mg/g gel is 0.6-2.4 mg q D
Progesterone helps initiate sleep 100 mg – 200 mg for women, and 100 mg for men
Testosterone prolongs Stage 3 & 4 sleep
Melatonin improves first 4 hours of sleep — 0.1-0.5 mg SL (increase dose by 5X if po)
GH improves first 4 hours of sleep — 0.05-0.65 mg SC HS
5-HTP 25-100 mg HS and Tryptophan 150-500 mg HS convert to Serotonin and
Melatonin for last 4 hours of sleep

When hormonal Txs don’t work:
Pt didn’t apply well or doesn’t understand dosage orders
Diet is protein deficient or XSV refined carbs
There are hormonal deficiencies which remain untreated
Pt is relatively resistant to hormonal Txs
Pt may be XSVly sensitive to some hormonal Txs
Pt may become more hormonal deficient after Rxing corrective hormones

Refined carbs dec Cortisol/GH/T/E2/DHEA/DHT/Aldosterone

PSYCHIATRY
Belgium, Brussels
March, 2014
~21~

Thyroid eventually decreases E2 and Cortisol

Estrogen eventually causes a Thyroid deficiency – is this why women are chubby
asks ROEFM

Cortisol eventually causes a Thyroid deficiency

If Thyroid Rx causes tachycardia and/or cardiac arrhythmia….use smaller doses, avoid only T3 Rx, increase dose more gradually, correct eventual Cortisol and E2 deficiency

If E2 Rx causes weight gain and/or breast tenderness….use smaller dose, avoid eating bad carbs, combine with Progesterone, correct eventual Thyroid deficiency

If Cortisol Rx causes easy bruising, skin thinning and/or weight gain….eat more healthy proteins, always combine with at least one other anabolic hormone (DHEA/T/E2/P/GH), use smaller doses, avoid EtOH/sweets 5/7 Ds

If GH causes adrenal burnout, flu, bronchitis….correct Cortisol deficiency, use smaller doses, avoid EtOH and sweets 5/7 Ds

If the hormone Tx doesn’t work because patient is resistant to the hormone Tx(s)….treat at higher doses, treat any Thyroid, Androgen, GH deficiency

If patient has excessive resistance to hormone Txs, e.g.,
Thyroid doesn’t work and there is weight gain instead of weight loss
DHEA doesn’t work and there is no effect on sleep
Melatonin doesn’t work, and there is still insomnia
Testosterone doesn’t work and there is still loss of libido
GH doesn’t work and there is no effect

Solution:

supply all hormones….Thyroid/T/DHEA/GH
GH may increase activity of hormone and the number of cell receptors
Rx higher doses
improve food intake

PSYCHIATRY
Belgium, Brussels
March, 2014
~22~

Sundry comments made by Dr. Hertoghe:

CFS Lancet, 1999, 353:455-458….low dose Cortef (5-10 mg/D) significantly improves fatigue of CFS patients

Decreased IGF-1 presents as decreased information processing speed

Buy IGF-1 from Internet….450 Euros/year

Flat hair is low Testosterone

Hair loss is low Testosterone and high DHT (Rx Proscar 2.5 mg for men, lower dose for women)

With resolution of depression, you see increased DHEA

Testosterone, Progesterone, Melatonin, and GH have anticonvulsant properties

Progesterone stimulates inhibitory GABA receptors

Progesterone can reduce fear

Progesterone TD is poorly absorbed but Rx Progesterone liposomal gel to chest, back of neck

Progesterone deficiency in men presents as tense upper back, and poor sleep

Progesterone decreases libido

Wet palms is a Cortisol and GABA deficiency

Excess GABA Sx is patient “wants to cry”

Lack of orgasm….Rx Histamine and Oxytocin

Intolerance to Rxs….Rx Histamine

Allergies require Betaine HCl

Cortisol increases DA (potentiates Adderall Rx questions ROEFM)

PSYCHIATRY
Belgium, Brussels
March, 2014
~23~

Sundry comments made by Dr. Hertoghe:

DA helps coordinate movement

Dopamine increases:
Cortisol
DHEA
T
E2

Dopamine decreases:
Prolactin

Serotonin decreases:
Dopamine (etiology of brain fog w/ Rx SSRIs)
Oxytocin (etiology of anorgasmia w/ Rx SSRIs)

Inositol increases St receptors and Serotonin enhances GABA

T cream will not penetrate….Rx liposomal gel

Melatonin will not work if lights are on

Patients with postpartum thoughts of harming infant, increased ACTH with no Cortisol response (adrenal weakness/Addison’s)

PSYCHIATRY
Belgium, Brussels
March, 2014
~1~

Crying requires good Thyroid function

SNS stimulated by Thyroid, E2, Adrenaline, Dopamine

PNS stimulated by T, DHEA, Progesterone, Cortisol, GH

Low E2, high P…….PMS, fatigue, depression (note PMS may require E2)

PMS REQUIRES E2 and/or P

High E2, low P…….PMS, anxiety, nervous

PNS XS Cortisol Symptoms: swelling, weight gain, slow thinking

SNS XS Thyroid Symptoms: nervousness, hyperkinesis, insomnia

Lab values indicating low Cortisol:
Dec T4, dec RT3, dec T4/T3
Inc T3

Happiness requires Thyroid, 5-HTP, Oxytocin, Cortisol, E2, T, GH

Unhappiness caused by decreased Thyroid, 5-HTP, Oxytocin, Cortisol, E2, T, GH

Oxytocin def. Symptoms:
disturbed by others, shy withdrawn, introvert, cold personality, feel worse at social events

Melatonin def. Symptoms:
symptoms mainly at night (although GI produces low doses of daytime Melatonin)
anxious, difficulty getting or staying asleep
doesn’t awaken refreshed

Melatonin relaxes mind and reduces consciousness

5-HTP/Serotonin helps create satisfied mind, non-frustrated consciousness

Thyroid def. Symptoms:
AM depression, puffy face, swollen lower eyelids/hands/feet
in PM less swollen
PSYCHIATRY
Belgium, Brussels
March
~2~

T def Symptoms:
hesitation, lack of self-assurance, fatigue

E2 def and P def Symptoms:
low mood, lack of femininity

P def Symptoms:
superficial, nervous sleep

Sadness/crying caused by:
low Thyroid, increased Oxytocin, decreased 5-HTP, dec. sex hormones
So patient who can’t cry needs……Thyroid, Oxytocin, 5-HTP, sex hormones

Conversion of Tyrosine to Dopamine requires
Pyridoxyl 5-Phosphate and Vit C

Dopamine increases GH/Cortisol/DHEA/T/E2

Dec. Dopamine will increase pain in Parkinson’s, Fibromyalgia, Burning Mouth

Dopamine def Symptoms:
fatigue, increased pain, increased weight, loss of motivation, ADD

Deficiency of DA/ST/GABA will increase sweet food cravings

Dopamine def Tx:
L-Dopa 150 g (Mucina Pruriens: 125 L-Dopa) per tsp, 1 tsp AM and lunch for one month
then, 1 tsp AM
L-Tyrosine 500 mg with B6: 1-2 po AM and lunch for one month
Phenylalanine 500 mg: 1-2 AM, and lunch

Dopamine XS Symptoms:
decreased Prolactin and too quick erections, psychosis, nausea

Dopamine decreases Prolactin

Noradrenaline/Adrenaline mechanism of action: increased heart rate releasing glucose form energy stores, increases blood flow to skeletal muscles

PSYCHIATRY
Belgium, Brussels
March
~3~

Sxs of NA/A def:
dec BP, nasal stuffiness, anxiety, poor focus, poor attention span

ST def FRUSTRATION and weight gain
GABA def ANXIETY and weight gain
NA/A and Dopamine def FATIGUE and weight gain

Noradrenaline/Adrenaline def Tx:
L-Tyrosine and Pyridoxyl 5-Phosphate 500 mg: 2 po AM and lunch for one month, then 1 po AM and lunch
Copper 2 mg, Vit C 1000 mg, adrenal support

Noradrenaline/Adrenaline XS symptoms:
anxiety, mania, tachycardia, high BP

Histamine is an excitatory NT involved in allergy, inflammatory response, orgasm

Histidine (NT precursor to Histamine) def: undermethlation per ROEFM
allergies and leaky gut
lack of orgasm
lack of stomach acid

Histamine Tx for lack of orgasm in women:
Histidine 500 mg NPO: 2 AM, 1 before lunch, and 1 HS for two months, then
1 AM and HS
P5P (Pyridoxyl 5-Phosphate)

Inhibitory NTs: Serotonin and GABA

ST benefits: happiness bursts during day, dec anxiety and frustration, dec hunger esp for sugar/sweet craving, increases Melatonin
Good for last 4 hours of sleep

ST dec alcohol/sugar/sweet cravings, abdominal pain, hostile depression (and suicide), bulimia/alcoholism

ST def frustration, GABA def anxiety/depression, NA/A def low energy/depression

PSYCHIATRY
Belgium, Brussels
March
~4~

DA def manifests as fatigue and anger outbursts

ST def Tx for depression:
5-HTP 25 mg, 1 po AM, 1 po before lunch, 1-4 po HS
Tryptophan at 4 PM, and AA mix 1-2 gms NPO BID or TID

ST def Tx to decrease appetite:
5-HTP 25 mg 1 AM, 10-15 mg after B, 10-15 mg before lunch, 10-15 mg 4 PM, 10-15 mg before dinner, and 50 – 100 mg HS with Tryptophan

ST XS Sxs:
yawning, increased transient digestive disorder, disgust for food, nausea

GABA def Sxs:
clammy hands, tachycardia, feel stressed

Sleep disorders caused by ST def (awakenings/difficulty last 4 hrs of sleep)
GABA def can’t relax at night

Acetylcholine (Ach) is NT in peripheral and central nervous system

Acetylcholine requires B1, B5 500 mg, E and C 1000 mg to make co-enzyme A. Choline combines with co-enzyme A to synthesize Acetylcholine

Acetylcholine actions:
In PNS…..induces contraction of skeletal muscles (think shuffling, slow awkward gait) inhibits contraction in cardiac muscle fibers, increases sweating
In CNS….necessary for plasticity and arousal, enhances sustaining attention (implicated to play role in memory deficits associated with SDAT)

Acetylocholine def Tx:
Choline 300 mg 2 AM, 2 lunch, 2 supper for 4 months, then 2 AM and 1 supper
Phosphatidylcholine (for dementia only) 400 mg 2 AM, 2 lunch, 2 dinner for 4 months,
then 2 AM, 1 Supper
Lecithin 1200 mg 2 AM, 2 lunch, 2 supper
Pantothenate 500 mg 1 AM
Thiamine B1 50 mg 2 AM
B Complex 1 AM
E (mixed tocopherols containing alpha, beta, gamma, and delta tocopherols)
Vit C 1000 mg

PSYCHIATRY
Belgium, Brussels
March, 2014
~5~

Lecithin is rich in choline and often better tolerated than choline
Lecithin is precursor to Acetylcholine
Lecithin used for treating: dementia, anxiety, gallbladder disease, liver disease, eczema

Overmethylation (Histapenics per ROEFM) patients have too little Acetylcholine
Undermethylation (Histadelics have high absolute Basophils) patients have too much Acetylcholine

Phosphatidylcholine can worsen depression (if undermethylation says RFM according to my research done at Princeton Bio Center, 1995)

Phosphatidylcholine IV for fatty deposits in arteries, inject SC for lipomas

Acetylcholine XS Symptoms:
headache, tense muscles in jaw/neck/shoulder, irritability/depression, insomnia
etiology of headache, depression, and insomnia in Histadelics (undermethylators)

GABA Tx:
GABA 750 mg 1-2 AM NPO, 1 4 PM, 1 HS
Inositol 300 mg 2 AM, 2 lunch, 2 HS

Delicate balance between SNS hormones Thyroid, E2, E, NE and
PNS hormones Cortisol, Progesterone, Melatonin, GH, (Ach)

Reduce nervousness/irritability ~ Cortisol, Progesterone, and GH

Cortisol def. symptoms:
chronic fatigue, conjunctivitis, gastroenteritis, colitis, arthritis, joint pain, eczema, dermatitis, pigment spots on lips, dark undereye circles, frequent flu and infections, allergies, irritable with lack of energy, sugar cravings, increased catecholamines
(NA/A derived from adrenal medulla), hypochondriacal, outbursts of anger, negative, blaming, perfectionistic

With cortisol def. there is compensatory release of NE and E

Cortisol increases Dopamine

Catecholamines (DA,NE/E) are derived from adrenal medulla

Tyrosine coverts to L-Dopa converts to Dopamine

PSYCHIATRY
Belgium, Brussels
March, 2014
~6~

Postpartum thoughts of harming infant secondary to inc ACTH but no inc Cortisol secondary to adrenal weakness

Tricyclic antidepressants dec awakening Cortisol levels lending to perfectionism

Cortisol def Tx in women:
Mild 10/5 mg breakfast, 10 mg lunch
Moderate 15 mg breakfast, 10 mg lunch
Severe 20 mg breakfast, 10 mg lunch

Cortisol def Tx in men: men have 50% larger adrenal glands
Mild 20 (15)/10
Moderate 25 (20)/10 (5)
Severe 30/10 (5)
Stress/Sports + 50-150 %
Flu/Asthma +100-200%

Tx for acute stress is 5-10 mg/D of Hydrocortisone or 2.5 mg/D of Predni(sol)one

Overconsumption of Cortisol HS requires Melatonin so patient has enough AM Cortisol

25 mg Cortisone equal to 20 mg Hydrocortisone

Balance Cortisol with androgens esp. DHEA, E2, Melatonin, GH

Inhibits Cortisol:
Melatonin/GH/IGF-1/DHEA/E2/Oxytocin/MSH II/Vasopressin/E2, especially po E2

In the following order…..C, GH (0.1 mg = 0.3 IU), P, Melatonin, Magnesium (300-600 mg of elemental Magnesium AM, additional dose of 200 mg with stress, Serotonin (5-HTP) 25/10-15/10-15/10/50 HS, GABA 500 AM…………………… reduce anxiety and nervousness

Note that Potassium in fruit kicks out Magnesium

L-Tryptophan converts to 5-HTP and with B6 converts to Serotonin and 5HIAA

Melatonin decreases: Melatonin increases PNS
irritability, ST excitatory secretion in brain at night, NE/E, Dopamine (note Xyrem dec DA and NE), Glutamate, Cortisol

PSYCHIATRY
Belgium, Brussels
March, 2014
~7~

Melatonin increases:
number of receptors in cerebral cortex for benzodiazepines
Rx Melatonin with benzodiazepines = 1 + 1 = 3 to taper off benzodiazepines

Women with hysteria need Testosterone

Women with irritability need Testosterone

4 hormonal excesses that increase nervousness and irritability are Th/C/E2/T

Thyroid excess present as underactive anxious nervousness, seen in patients with low Cortisol and high caffeine intake which cause excess conversion of T4 to T3, patients have high T3…..Tx Cortisol and decrease caffeine

Cortisol excess present as overactive euphoric nervousness, Cortisol Tx presents as XS Cortisol when patient eats refined carbs…..Tx stop overeating carbs

Estrogen excess Sxs: negative, aggressively nervous, often premenstrual when Progesterone def. (E2 converts to less active E1 with Progesterone), or overtreatment with E2

Testosterone excess Sxs: overactive, dominant, afraid of nothing nervousness, irritable when frustrated, endogenous high Testosterone levels coverts to E2, or exogenous Testosterone Tx in presence of untreated GH def.

Melatonin XS Symptoms:
very deep and short sleep (3-4 hours)
excessively long deep sleep
intense dreams

Melatonin Tx:
0.1 – 1 mg SL 10 mins P/T HS
increase dose up to 2-6X if stressful day or jet lag
Mild def 0.05 mg SL, avg 0.2 mg SL
Moderate def 0.1-0.2 mg SL, avg 1 mg
Severe def 0.2-0.5 mg SL, avg 3 mg

Melatonin po poorly absorbed (inc dose 5X for po)
Mild def 0.3 mg PO
Moderate def 1.5 mg PO
Severe def 10 mg
PSYCHIATRY
Belgium, Brussels
March, 2014
~8~

Oxytocin deficiency presents as shyness, stressed by presence of others

Thyroid deficiency presents as wake-up depression

Cortisol deficiency presents as unable to handle stress, everything is too much

DHEA deficiency presents as feeling mild distress all day

Aldosterone deficiency presents as increased distress upon standing, and everything is too much

E2 Progesterone deficiency presents as distress during activities, including sexual

T deficiency presents as distress during physical activities, including sexual

Nutritional Txs to improve stress resistance:
Magnesium stops irritability, 200-800 mg elemental magnesium (Doctor’s Best Magnesium)
5-HTP removes frustration, 25 mg AM, 50 mg HS
GABA decreases anxiety and improves ability to relax, 750-1500 mg/D

PMS Tx w/ B6 (P5P 1-2 50 mg AM), Magnesium, possibly Progesterone

Hormones to increase stress resistance in order of importance are C, T, GH, Melatonin HS, Oxytocin

2 hormone Tx XS that worsen stress resistance are Th and E

Melatonin
Oxytocin
GH ALL REDUCE CORTISOL & WORSEN STRESS RESISTANCE
IGF-1
DHEA
Aldosterone

Hypochondria hormonal dysfunctions:
low Cortisol (hypochondria with suspicion)
low GH (hypochondria with anxiety and dramatizing)
low T
XS E2 in men
XS PTH
PSYCHIATRY
Belgium, Brussels
March, 2014
~9~

Burnout critical def. is Cortisol

Cortisol inc. Dopamine (Rx Cortisol w/ Adderall)

People who hate are low Cortisol

Burnout Tx with Thyroid:
Tx very slowly
Increase +15-30 mg or 5-20 ug T3 if intellectual challenge

Poor resistance to noise are DHEA def.

DHEA def. Sxs: fatigue, depression, anxiety, poor resistance to stress and noise

Treatments for anxiety in order of importance:
GH
E2 in women
Cortisol
Oxytocin
P especially for women
Melatonin

Other hormones that may reduce anxiety:
Thyroid
DHEA especially beneficial for women
E2 in women, and in men if low E2 (usually not on T Tx)

HRT for solitude and social withdrawal:
OXYTOCIN esp in ASD and Schizophrenia, O is the positive emotion hormone
GH
E2
T
Prolactin
Cortisol

Low Oxytocin and low Vasopressin (both produced by same neurons of posterior pituitary) both decrease ability to form social bonds, need Oxy for affectionate mind

PSYCHIATRY
Belgium, Brussels
March, 2014
~10~

Oxytocin may increase Vasopressin and cause edema in 1/3000 patients

Oxytocin may precipitously decrease Cortisol at dose of more than 5/IU

Oxytocin XS Sxs:
heavy head
low BP
overwhelming desire to have sex with partner
premature ejaculation
too quick orgasm in women
painful uterine, vaginal, anal contractions at orgasm
sticky, dependent behavior with partner
XSV dependence on compliments

People with adequately high Oxytocin need 8-10 hours of sleep

Serotonin dec Oxytocin…..hence etiology of difficult or impossible to climax

Oxytocin acts as anxiolytic and reduces amygdala action, activates neurons in central nucleus of amygdala (CeA)

Headaches and hormone Tx:
most headaches are caused by muscular contraction or blood flow problems
headaches may be triggered by head trauma, tumors, stress, dilated blood vessels,
muscular tension, low level of endorphins
sinus HAs caused by inflammation or congestion…pain behind brow bone and/or
cheekbones
cluster HAs are one sided, drooping of lid, with tearing….pain is in and around one eye
tension HAs are the most common HA, sensitivity (or lack of) sensitivity to pressure on
trigger points in upper trapezius, masseter, temporal, pterygoid and
sternocleidomastoid muscle…pain is like a band squeezing head
vascular HAs are migraines which constrict and open blood vessels…migraines result in
pain, nausea and visual changes

Thyroid relieves morning HAs
Estrogen relieves menstrual HAs
Progesterone relieves premenstrual HAs
Cortef/Prednisolone relieves stress/inflammation chronic sinusitis HAs
Melatonin relieves nighttime HAs
Desmopressin relieves dehydration HAs

PSYCHIATRY
Belgium, Brussels
March, 2014
~11~

Dexamethasone used for HAs and hirsutism

IV Dexamethasone decreases HAs more effectively than morphine

E2 Tx in menstrual period relieves premenstrual/beginning of menses HAs

Oestradiol patches in menstrual period only have slight effect on menstrual HAs

Progesterone decreases premenstrual brain edema HAs

Tension, sinus, and cluster HAs are facilitated by a Cortisol def.

Migraines are facilitated by a Thyroid and Estrogen def.

Headaches during the night are facilitated Melatonin def.

Melatonin def. may be due to a pineal gland cyst

Melatonin mechanism of action is antinociceptive (reduced sensitivity to painful stimuli) and stimulation of opioid receptors

Cluster HAs demonstrate decreased 24 hour serum Melatonin

HAs may be caused by Vasopressin deficiency

Decreased plasma Noradrenaline (NE) have HAs in fatigue conditions

Noradrenaline (NE) affects mood (Adderall inc. DA and NE) def Sxs stuffy nose and orthostatic Hypotension, Adrenaline (E) affects memory

NE requires B9 (Folic Acid) to convert to E(pinephrine)

Depression due to malfunction of NE pathways; i.e., high homocysteine (indicating def. of folic acid, B12, and B6) decreases production of catecholamines like NE/E/Dopamine

NE/E def. Sxs = stuffy nose, orthostatic hypotension

PSYCHIATRY
Belgium, Brussels
March, 2014
~12~

Major hormones for Tx of depression in order: 1) Sex hormones (E2/P/T), E2 acts as MAO-I to increase ST and brain opioids, 2) Thyroid stimulates cerebral blood flow, 3) GH, 4) Oxytocin, 5) Melatonin, 6) Cortisol, 7) DHEA (for women Tx w/ T/Thyroid/DHEA)

Oxytocin mechanism of action for depression ~ Oxytocin increases Beta endorphins

Primary Hypothyroidism: dec Free T4, inc TSH, inc. TSH response to TRH
Secondary hTH “subclinical”: normal Free T4, inc TSH, inc. TSH response to TRH
Tertiary Hypothyroidism: normal Free T4, normal TSH, inc. TSH response to TRH

Hypothyroid more prevalent in patients with refractory depression to antidepressant Rx

Definition of Sheehan Syndrome: much blood loss during childbirth…oxygen deprivation…pituitary damage, resulting in permanent underproduction of all pituitary hormones

Bipolar Rapid Cycling (4-50 episodes/year) have Thyroid deficiency

T3 25 mcg/D in combination with tricyclic antidepressants augment therapeutic response in patients who are euthyroid….suggesting an insufficient supply of T3 to brain of depressed patients

Tx of postpartum depression: Tx one month postpartum (or patient will bleed) with E2 TD 0.75 – 1.5 (2.25) mg/D on Days 1-25/27 of the month and Progesterone PO 100 mg/D on Days 1-25/27 of the month as needed

Bipolar Tx:
Thyroid first
E2 and P and T second
GH third

Neuroendocrine markers of melancholia: 1) failure of suppression of plasma Cortisol secretion in the DX-suppression test, 2) decreased TSH response to TRH, 3) decreased GH response to stimulating agents (Insulin, L-Dopa, amphetamines, IGF-1, and Clonidine increase GH)

Selegiline (increases Dopamine in Parkinson’s) and MAO-I anti-depressants like Meclobemide and Clorgyline increase Melatonin production

Melatonin good for night depression
PSYCHIATRY
Belgium, Brussels
March, 2014
~13~

Unipolar depression have lower intracellular lymphocytic Cortisol receptors, Rx Cortisol, and have dec NE (Th, E2, and P increase Catecholamines in women)

Cortisol paradox in depression is that there are high levels of Cortisol at night that keep patient awake, and poor response to stress (Cortisol should increase) during the day

In depression there is dysfunction of pituitary ACTH axis

Cortisol Mechanism of Action for Depression:
Inc levels of DA receptors in striatus (pleasure), hippocampus (emotions), gray matter
Inc Adrenaline receptors in cerebral cortex
Inc GABA receptors
“Possibly” activation of increased ST (Serotonin) receptors and less activation of HPA axis by ST receptors

Lab values indicating Cortisol def. are dec T4, dec Reverse T3, dec T4/T3, incr T3

Cortisol XS may result in euphoria/hypomania, Cortisol def. results in depression

Hormonal imbalances w/ Hypomania:
increased Cortisol, decreased Thyroid, decreased Melatonin

DHEA Tx for one month of 30-90 mg a day for middle-aged and elderly patients; studies show marked resolution of depression with 90 mg/D for six weeks; note that 3 weeks of 90 mg and 3 weeks of 450 mg did not improve outcome over 90 mg/D for six weeks

You will see increase of DHEA with resolution of depression

DHEA decreases neuroexcitatory Pregnenolone Sulphate

Morning depression requires Thyroid
Whole day depression requires T first, E2, and P
Overwhelming depression requires GH
Stress induced depression requires Cortisol

PSYCHIATRY
Belgium, Brussels
March, 2014
~14~

Impulsivity Hormonal Imbalances:
Cortisol def.
GH def.
T def.
P def. in women
E2 XS in women

Mood Swings and Emotional Lability Hormonal Dysfunctions:
Cortisol XS in men (reduce w/ Melatonin SL 0.1-0.2 HS, Oxytocin SL 5-15 IU/D, & GH)
GH def. (0.1-0.2 mg/D),T XS in men (reduce with Thyroid Rx, lower patient’s intake of meat), P def in women, E2 XS in women

Suicidal Ideation: Rx C AM, Rx Melatonin HS, GH calms continuous adrenaline surge, suicide attempt done during adrenaline surge

You will see inc. DHEA with resolution of depression

20 mg Cortisol, you need to Rx 20 mg of DHEA po (DHEA TD poorly absorbed)

Men need more DHEA – 50 mg., men’s adrenal glands are 50 % larger

Bipolar Rapid Cycling:
Thyroid – increased prevalence of hypothyroidism occurs with rapid cycling
70% improvement with Thyroid Rx
1/3 have antithyroid antibodies

Hypomania suggest disturbance in hormonal and NT levels:
increased Cortisol
decreased Thyroid
decreased Melatonin
decreased ACh
increased Catecholamines (DA, NE, E)
disturbance of Amino Acids

Hypomania Tx:
Thyroid Armour 30-180 mg.
Melatonin (reduces Cortisol) SL 0.05-0.5 mg HS
GH (reduces Cortisol) SC 0.1-0.3 mg
Tx to reduce Catecholamines
Tx to increase ACh
PSYCHIATRY
Belgium, Brussels
March, 2014
~15~

Tx with PNS stimulating hormones: GH, IGF-1 Progesterone, T, Melatonin
Note that Thyroid stims production of several PNS hormones

Bipolar II Depression:
prominent Sx of Bipolar II is depression, with displays of mania via irritation, agitation,
short fuse

Tx Bipolar II Depression:
Dessicated Thyroid, chew, 30-180 mg
Cortef 20mg w/ B and L for women, 30 mg w/ B and L men OR PREDNIS(OL)ONE OR METHYLPREDNISOLONE
EITHER CORTISOL OR PREDNISOLONE OR METHYLPREDNISOLONE
Prednis(ol)one 5 mg upon awakening
Methylprednisolone (Medrol) 4 mg/D
Melatonin SL 0.05-0.5 mg HS inc GH
GH SC 0.1-0.3 mg HS (Note: GH may precipitously lower Cortisol)
Estradiol TD 0.06% 1-3 grams Ds 1-25 AM
Progesterone 100-200 mg (for 11 to 15 days) HS
Testosterone gel 0.5% 1/3-1/2 gram AM for women, 10%1/2-3 grams AM for men

Bipolar Tx during Mania:
Thyroid
Melatonin to dec XS Cortisol
GH to dec XS Cortisol
5-HTP 25 mg upon awakening, possibly every 2 hours 10-15 mg, 50-100 mg HS
BEST HTP FROM SAFFRANE (helps sleep)
If patient is taking Seroquel which is ST antagonist, DO NOT Rx 5-HTP which is a ST agonist

Lithium Tx:
Lithium carbonate 300 mg HS, Thyroid AM (Lithium lowers Thyroid)

Lithium increases TSH and lowers Thyroid

Lithium decreases:
T4
Sex Hormones (Estradiol, Progesterone, DHEA, T, DHT)

PSYCHIATRY
Belgium, Brussels
March, 2014
~16~

Autism:
embryologically, pituitary glands begins to form in week 4

DECREASED IN AUTISM:
Melatonin
IGF-1
Oxytocin
Thyroid
Cortisol

INCREASED IN AUTISM (anabolic hormones):
Testosterone (Free and Total)
DHEA
DHT

Genetic disturbance of Oxytocin and Vasopressin Receptors in Autism

AUTISM Tx for deficiencies:
Oxytocin 1-3 IU/D
Armour Thyroid 7.5-120 mg/D OR Synthetic T4/T3
Cortef 2-3 mg TID (3 yo), 5-7 mg BID (8 yo) OR…Prednisolone 2.2.5 mg/D over 7 yo
Fludrocortisone 30-70 mcg/D
GH 0.05-0.10 mg/D
EPA 250 mg/D with DHA 500 mg/D

Endocrine disruptors definition:
MIMIC the effects of normal hormones by binding to receptors
BLOCK the effects of a hormone by blocking the binding of the hormone to the receptor
BLOCK synthesis of the hormone
DISTURB the effects by interfering with the hormone transport, or its elimination

PSYCHIATRY
Belgium, Brussels
March, 2014
~17~

SCHIZOPHRENIA ETIOLOGIES:

Prenatal famine decreases intracranial volume and decreases pituitary hormones
Deficiency of Oxytocin and/or Oxytocin receptors perinatally
Inc. Homocysteine may precipitate Schizophrenia
Exposure to genital/reproductive infections perinatally may precipitate Schizophrenia
Inc. Lead may precipitate Schizophrenia
H/O autoimmune disorders
late winter birth
small for gestational age
bleeding during pregnancy
DYSFUNCTION OF HPA AXIS

DECREASED IN SCHIZOPHRENIA:
Estradiol
Progesterone
Oxytocin (insensitive Oxytocin receptors)
Thyroid
T
GH
Melatonin (note that children require higher doses)
DHEA (w/ increased C/DHEA ratio)
Cortisol (inc. ACTH but unresponsive to stim w/ result of dec. Cortisol) – ALSO NOTE THAT IT IS MORE DIFFICULT TO SUPPRESS ADRENALS IN CHILDREN

INCREASED IN SCHIZOPHRENIA:
Lead
Homocysteine
Prolactin
increased ACTH – unresponsive to stimulation with resultant decreased Cortisol

PSYCHIATRY
Belgium, Brussels
March, 2014
~18~

Schizophrenia Tx for deficiencies:
Oxytocin 10/IU in AM
GH 0.10-0.50 mg/D
Thyroid Armour 45-210 mg/D or Synthetic T4 and T3 (neuroleptics dec. Thyroid)
Cortisol 15-30 mg for women, and 25-40 mg for men (neuroloeptics dec. Cortisol)
Aldosterone (Fludrocortisone) 100-150 mcg/D
Testosterone for women TD 2-5 mg/D
Testosterone for men TD 75-200 mg/D or IM 100-150 mg/week
Estrogen TD E2 1.5-4 mg/D for women- prem. Ds 5-25, postmenopausal 1-25
Progesterone 50-100 mg for women – premenopausal Ds 5-25, postmenopausal 1-25

Neuroleptics decrease Thyroid and decrease Cortisol

Acute Psychosis Deficiencies: dec T4, dec. T3, dec Free T4, dec T

DHEA and Estradiol decrease positive, negative, and extrapyrimidal Sxs of schizophrenia

Miscarriages may be secondary to Mercury intoxication in uterus

Estradiol and Progesterone decrease positive and negative Sxs of Schiz in women

Testosterone decreases schizophrenia symptoms in men

Addison’s Disease Sxs:
apathy, negativism, quarrelsomeness, irritability, depression, psychosis
rarely psychosis with paranoid trends

Paranoia hormonal deficiencies:
Cortisol (see Addison’s Disease Sxs above) 15-35 mg/D or Prednis(ol)one 5 mg/D
Low adrenal hormones…..Cortisol, DHEA, Progesterone, etc.
DHEA 15-50 mg/D
Aldosterone (Fludrocortisone) 0.1 mg/D
Oxytocin (anxiolytic (calms anxiety) by activating neurons in central nucleus of amydala) Oxytocin 5 IU AM and 5 IU HS
GH 0.1-0.25 mg/D
LOW or HIGH Testosterone levels

PSYCHIATRY
Belgium, Brussels
March, 2014
~19~

Sexual arousal in women:
oophorectomized women lose 80% of Testosterone during surgery, Rx T TD10 mg
always provide E2 and Progesterone with androgens to prevent virilization
E2 and Testosterone increase libido, but E2 requires T to work
Bremelanotide and Melanotan II (MSH) increases sexuality, 0.1 to 0.3 mg/week – 0.05 to 0.15 2X wk
DHEA 10-30 mg for women and 50 mg for men
Oxytocin 5 IU AM and HS

Rx Resistant Cases of loss of sexual arousal in women:
T SC 20 mg q other week to max. of 80 mg/month
DHT 2.5% (Andractim) cream applied to clitoral hood

Sexual arousal in men:
TD T gel 0.5 — 1/2 to 1 gram/D — 2.5-5 mg/D
Melanotan II 0.1 mg 3X week
DHEA 50 mg
Oxytocin 5 to max at IU/D AM and HS (sublingual)

Cyproterone acetate blocks the peripheral action of DHT…..dec mounting and intromission frequencies block ejaculatory behavior, dec DHT stimulated seminal vesicle and penile weight lengths

Sexual desire in men is influenced (and possibly even more by its direct metabolite E2 in men) – low Estradiol in men loss of sexual desire

Buy book Best Erotic Fantasies by Harold Litten

Top 6 hormones to improve Dementia, Alzheimer’s Type:

Thyroid Tx improves brain blood flow, provides oxygen, nutrients and water to brain to cells, reduces progression of atherosclerosis, improves memory
Pregnenolone min 100 mg in AM
Estrogen and Progesteorne
Testosterone improves memory
GH repairs nerves, slows down brain and neuronal deterioration, improves memory
Vasopressin/Desmopressin improves water content of brain and improves memory

PSYCHIATRY
Belgium, Brussels
March, 2014
~20~

Too high or too low TSH increases risk of Alzheimer’s

Patients with Parkinson’s and Alzheimer’s have dec. Estradiol and dec. BDNF

High Estrogen levels are risk factor for development of MS

GH, Cortisol and Melatonin permits patients to remain at home longer

Sleep disorders:
Melatonin
GH deepens and prolongs sleep Stage 3 & 4, REM sleep (which is Stage 5), and
reduces Stage 1 & 2 superficial sleep
IGF-1 produces longer and deeper sleep
Oxytocin
Thyroid prolongs Stage 3 & 4 sleep…..and reduces sleep apnea snoring
XS THYROID CAUSES TACHYCARDIA, CARDIAC ERETHISM (ABNORMAL
CARDIAC RHYTHMS), PREVENTS FALLING ASLEEP, AND REDUCES STAGE
3 & 4 SLEEP
If patient has abnormally high evening and bedtime Cortisol causes insomnia
If patient requires Cortisol at night…..5 mg Cortef HS prevents nighttime eating
DHEA at high doses prolongs REM Stage 5 sleep
Estrogen prolongs Stage 3 & 4 sleep — E2 gel 1-4 g of 0.6 mg/g gel is 0.6-2.4 mg q D
Progesterone helps initiate sleep 100 mg – 200 mg for women, and 100 mg for men
Testosterone prolongs Stage 3 & 4 sleep
Melatonin improves first 4 hours of sleep — 0.1-0.5 mg SL (increase dose by 5X if po)
GH improves first 4 hours of sleep — 0.05-0.65 mg SC HS
5-HTP 25-100 mg HS and Tryptophan 150-500 mg HS convert to Serotonin and
Melatonin for last 4 hours of sleep

When hormonal Txs don’t work:
Pt didn’t apply well or doesn’t understand dosage orders
Diet is protein deficient or XSV refined carbs
There are hormonal deficiencies which remain untreated
Pt is relatively resistant to hormonal Txs
Pt may be XSVly sensitive to some hormonal Txs
Pt may become more hormonal deficient after Rxing corrective hormones

Refined carbs dec Cortisol/GH/T/E2/DHEA/DHT/Aldosterone

PSYCHIATRY
Belgium, Brussels
March, 2014
~21~

Thyroid eventually decreases E2 and Cortisol

Estrogen eventually causes a Thyroid deficiency – is this why women are chubby
asks ROEFM

Cortisol eventually causes a Thyroid deficiency

If Thyroid Rx causes tachycardia and/or cardiac arrhythmia….use smaller doses, avoid only T3 Rx, increase dose more gradually, correct eventual Cortisol and E2 deficiency

If E2 Rx causes weight gain and/or breast tenderness….use smaller dose, avoid eating bad carbs, combine with Progesterone, correct eventual Thyroid deficiency

If Cortisol Rx causes easy bruising, skin thinning and/or weight gain….eat more healthy proteins, always combine with at least one other anabolic hormone (DHEA/T/E2/P/GH), use smaller doses, avoid EtOH/sweets 5/7 Ds

If GH causes adrenal burnout, flu, bronchitis….correct Cortisol deficiency, use smaller doses, avoid EtOH and sweets 5/7 Ds

If the hormone Tx doesn’t work because patient is resistant to the hormone Tx(s)….treat at higher doses, treat any Thyroid, Androgen, GH deficiency

If patient has excessive resistance to hormone Txs, e.g.,
Thyroid doesn’t work and there is weight gain instead of weight loss
DHEA doesn’t work and there is no effect on sleep
Melatonin doesn’t work, and there is still insomnia
Testosterone doesn’t work and there is still loss of libido
GH doesn’t work and there is no effect

Solution:

supply all hormones….Thyroid/T/DHEA/GH
GH may increase activity of hormone and the number of cell receptors
Rx higher doses
improve food intake

PSYCHIATRY
Belgium, Brussels
March, 2014
~22~

Sundry comments made by Dr. Hertoghe:

CFS Lancet, 1999, 353:455-458….low dose Cortef (5-10 mg/D) significantly improves fatigue of CFS patients

Decreased IGF-1 presents as decreased information processing speed

Buy IGF-1 from Internet….450 Euros/year

Flat hair is low Testosterone

Hair loss is low Testosterone and high DHT (Rx Proscar 2.5 mg for men, lower dose for women)

With resolution of depression, you see increased DHEA

Testosterone, Progesterone, Melatonin, and GH have anticonvulsant properties

Progesterone stimulates inhibitory GABA receptors

Progesterone can reduce fear

Progesterone TD is poorly absorbed but Rx Progesterone liposomal gel to chest, back of neck

Progesterone deficiency in men presents as tense upper back, and poor sleep

Progesterone decreases libido

Wet palms is a Cortisol and GABA deficiency

Excess GABA Sx is patient “wants to cry”

Lack of orgasm….Rx Histamine and Oxytocin

Intolerance to Rxs….Rx Histamine

Allergies require Betaine HCl

Cortisol increases DA (potentiates Adderall Rx questions ROEFM)

PSYCHIATRY
Belgium, Brussels
March, 2014
~23~

Sundry comments made by Dr. Hertoghe:

DA helps coordinate movement

Dopamine increases:
Cortisol
DHEA
T
E2

Dopamine decreases:
Prolactin

Serotonin decreases:
Dopamine (etiology of brain fog w/ Rx SSRIs)
Oxytocin (etiology of anorgasmia w/ Rx SSRIs)

Inositol increases St receptors and Serotonin enhances GABA

T cream will not penetrate….Rx liposomal gel

Melatonin will not work if lights are on

Patients with postpartum thoughts of harming infant, increased ACTH with no Cortisol response (adrenal weakness/Addison’s)