Louis B. Cady, MD – CEO & Founder – Cady Louis B. Cady, MD – CEO & Founder – Cady Wellness Institute Wellness Institute Adjunct Asst. Prof of Psychiatry – Indiana University School of Medicine Department of

PsychiatryChild, Adolescent, Adult, Functional Neuropsychiatry –

Evansville, Indiana

Hormones, Cognitive Dysfunction & Depression in Older Adults

AMMG Fall Conference – Nov. 2, 2012 – General Session Curriculum 2:00 – 2:45 pm Las Vegas, NV - USA

H - 2

“There are two objects of medical education: to heal the sick and to advance the science.”

- Dr. Charles H. Mayo, MD

“The glory of medicine is that it is always moving forward, that there is always more to learn.”

- Dr. William J. Mayo

Purpose of this talk:• Real-world, clinical application of age

management concepts

• Avoiding “knee-jerk” reaction for “just depression.”

• Understanding relevance of thyroid, cortisol and several other hormones in affective and cognitive dysfunction

• Review of cost-effective ways of screening for hormonal and neurotransmitter abnormalities

How to get the MOST out of this presentation:

My bias: whatever works for the patient; whatever it takes.

Topics:

• Thyroid

• Cortisol

• DHEA

• Estradiol/Progesterone

• Testosterone

• Lab techniques: saliva or blood?

AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTSMEDICAL GUIDELINES FOR CLINICAL PRACTICE

FOR THE EVALUATION AND TREATMENT OFHYPERTHYROIDISM AND HYPOTHYROIDISM

AACE Thyroid Task Force

ChairmanH. Jack Baskin, MD, MACE

Committee MembersRhoda H. Cobin, MD, FACEDaniel S. Duick, MD, FACEHossein Gharib, MD, FACE

Richard B. Guttler, MD, FACEMichael M. Kaplan, MD, FACE

Robert L. Segal, MD, FACE

ReviewersJeffrey R. Garber, MD, FACE

Carlos R. Hamilton, Jr., MD, FACEYehuda Handelsman, MD, FACP, FACE

Richard Hellman, MD, FACP, FACEJohn S. Kukora, MD, FACS, FACE

Philip Levy, MD, FACEPasquale J. Palumbo, MD, MACESteven M. Petak, MD, JD, FACE

Herbert I. Rettinger, MD, MBA, FACEHelena W. Rodbard, MD, FACE

F. John Service, MD, PhD, FACE, FACP, FRCPCTalla P. Shankar, MD, FACESheldon S. Stoffer, MD, FACE

John B. Tourtelot, MD, FACE, CDR, USN

2006 AMENDED VERSIONThis amended version reflects a clarification to specify pertechnetate as the

compound attached to 99mTc.

ENDOCRINE PRACTICE Vol 8 No. 6 November/December 2002 457

http://www.umm.edu/patiented/articles/how_serious_hypothyroidism_000038_6.htm

• “Thyrotropin (Thyroid-Stimulating Hormone or TSH). Measuring TSH is the most sensitive indicator of hypothyroidism.” (hunh?!) – accessed 9/5/2011

• “…blood tests for measuring levels of TSH and free thyroxine (T4) are the only definitive way to diagnose hypothyroidism” – 10/6/2012

“the foot soldier” “the evil twin”

Selenium required!

FEEDBACK INHIBITION

CORTISOL

North America 85%

South America 76%

Asia 76%

Africa 74%

Europe 72%

Australia 55%

% Mineral depletion from the soil during the past 100 years, by continent

Source: UN Earth Summit Report 1992

Jrnl of Amer. College of Nutrition Vol 23, No. 6, 669-682 (2004).

Objective: evaluate possible changes in USDA nutrient content data for 43 crops between 1950 – 1999; consider potential causes

Methods: ratios calculated for “R” 1999/1950

Results: as a group, the 43 foods showed apparently, statistically reliable declines for 6 nutrients: protein, Ca, P, Fe, riboflavin, and ascorbic acid.

- 6% decrease in protein- 38% decrease in riboflavin

CONCLUSIONS: trade off between yield and nutrient content

SELENIUM DEFICIENCY in FASEB:

• “Adaptive dysfunction of selenoproteins from the perspective of the ‘triage’

theory: why modest selenium deficiency may increase risk of diseases of aging.”

Foundation of American Societies for Experimental Biology

McCann, J, Ames BM. FASEB J. 2011 Jun;25(6):1793-814.

(permission granted to use photos & data)

(permission granted to use photos & data)

• Early 20’s college student• Weight gain, fatigue, brain fog• Saw “numerous” MD’s asking for help• Told “nothing is wrong with your thyroid;

your labs are fine.”

(permission granted to use photos & data)

(permission granted to use photos & data)

Depressed mood 100%

Reduced energy: 97%3

Fatigue or loss of energy: 94%2 Impaired concentration: 84%3

Tiredness: 73%1

Hypersomnia: 10%–16%4 (Insomnia)

Useful Target Symptoms in Useful Target Symptoms in Major DepressionMajor Depression

1. Tylee et al. Int Clin Psychopharmacol 1999;14:139-151. 2. Maurice-Tison et al. Br J Gen Pract 1998;48:1245-1246. 3. Baker et al. Comp Psychiatry 1971;12:354-65. 4. Horwath et al. J Affect Disord 1992;26:117-25. 5. Reynolds and Kupfer. Sleep 1987;10:199-215.

Modern Medicine’s Paradigm: Two Standard Deviations – “if you are not

sick, then you must be well.”

“NORMAL”

OPTIMAL?

OPTIMAL

Average (normal) or optimal?• Would you like an normal wife (husband) or

an optimal one?• Would you like a “normal” marriage or an

exciting and optimal one?• Would you like a “normal” medical practice or

an incredible, exciting, and (optimal!!) stimulating one?

• Would you like “normal” labs or OPTIMAL ones?

Serum concentrations of Free T3, Free T4, morning cortisol, afternoon cortisol and change in cortisol concentrations.Adjustments for: age, sex, body mass index, hypertension, previous MI, heart failure, diabetes, NY Heart Assn. functional class, depressive symptoms and anxiety symptoms.

Lower Free T3 = more physical fatigueLower Free T4 = more exertional fatigueLower morning cortisol and change in cortisol concentration = more mental fatigue.

Aim: evaluate biological factors assoc. with suicide attempts in naturalistic sample439 patients with major depression, bipolar and psychotic disorders consecutively assessed in the ER of an Italian Hospital (Jan 2008-Dec 2009)

Suicide attempters were 2.27 times less likely to have higher Free T3 values than non-attempters (odds ratio = 0.44; 95% CI; p=0.01)(prolactin level differences failed to reach significance)

Treatment resistant depression is a common challenge.

Best augmenting strategies available:-Lithium -Thyroid hormone-Anti-anxiety medications-Atypical antipsychotics.

Per HDRS – 17, remission in:15.9% on Li24.7% on T3

Per QIDS-SR16, remission in:13.2% on Li24.7% for T3 *

* Fava & Covino: Augmentation/Combination Therapy in STAR*D Trial, Medscape Psychiatry

LEVEL III RESULTS:

63 patients with “subclinical hypothyroidism” HAM-D and MADRS scales with serum TSH Free T4, free T3 TPO AB and Tg-AB levels

“This study suggests the importance of a psychiatric evaluation in patients affected by subclinical hypothyroidism.”

Prevalence of depressive symptoms in this population was 63.5%

Hunh?

Aim: Evaluate relationship of subclinical hypothyroidism and cognition in the elderly. - 337 outpatients; {177 = men; 160 = women}

“Patients with subclinical hypothyroidism had a probability about 2 times greater (RR = 2.028, p<0.05) of developing cognitive impairment.”

MMSE scores were SIGNIFICANTLY lower in subclinical hypothyroid patients compared to euthyroid (p<0.03)

The Glamorous Grandmother• 4/8/11 – 80 yo returned to practice. No real

complaints. History of depression. On des-methylvenlafaxine.– Daughter “handling her finances”

• 5/2/11 – “doing terrible.” – TSH 3.84, Free T3 2.8 – on 50 MICROgrams T4– Fasting BS 120; HgBA1C 6.5%– Fasting insulin 36 (!!!) {3 – 25}– Progesterone – 0.2 {0.2 – 1.4 follicular}– Total testosterone 11– DHEA-S = 25 MICROgrams/dL (!!)

• Age adjusted {10 – 90} . Optimal = {c. 350-500}• Rouzier = {300 –females, 600 males}

G.G. - interventions 5/2/11 & Follow-up

• Interventions:– DHEA – 25 mg SR q a.m.– Progesterone 50 mg then 100 mg HS,

transdermal. – Testosterone – 2 mg for one week, then 4 mg

transdermal– Referred to better MD for intervention with

AODM.

• 6/13/2011 – improvement in fatigue. Labs rechecked.

• 7/11/2011 – “feeling wonderful”

G.G. – labs before and after

4/11/11 interventions 7/11/11 changes

TSH 3.84 Raise T4 from 50 – 75 ug

0.01 (L) none

FT4 1.16 “ 1.24 “

FT3 2.8 “ 3.3 “

Progesterone <0.2 100mg topical HS

0.9 None

Testosterone 11 4mg topical 15 4 mg LABIAL

DHEA-S 25 25 mg SR n/a continue

24 post-menopausal women with intact uterus. Neuropsych testing. No hormone therapy used in the past. Recruited by newspaper ads.

Mood improved in all groups.

Randomized to CEE + PL, CEE + MPA, CEE + MP (Micronized progesterone)

CEE + MP performed significantly better on a test of working memory than the other two groups.

Medroxyprogesterone in women and rats• MPA – used in hormone therapy and as

DepoProvera, is implicated in detrimental cognitive effects in women.

• In ovariectomized rodents – MPA impairs cognition and alters the GABA-ergic system.

• Findings suggest that MPA treatment leads to LONG-LASTING cognitive impairments in the rodent, even in the absence of ongoing circulating MPA

Braden BS, et al. Cognitive-impairing effects of medroxyprogesterone acetate in the rat: independent and interactive effects across time.

Psychopharmacology (Berl). 2011 Nov;218(2):405-18. Epub 2011 May 12.

The glamorous grandmother – post tune-up: DHEA, thyroid, testosterone, progesterone

9/28/2011 (permission granted to use photos & data) 01/26/2012

Photos removed for internet slideshare and .pdf postings

October 12, 2012 – used with permission

Photos removed for internet slideshare and .pdf postings

Conclusions regarding thyroid

• It’s not just about eyebrows (or reflexes)

• Low or subclinical hypothyroidism associated with:– Depression– More exertional and mental fatigue– Higher risk of suicide• Poorer cognition• 2 x likelier to have cognitive impairment.

The state of adrenal exhaustion can be determined

• 53 year old male executive• Partner in four businesses. • “The last year or so, I’m

more tired… don’t have the energy… I’m having more trouble getting out of bed in the morning.”

Other hormone markers by salivary & conventional testing

• DHEA 120.12 pg/ml (L) {137 – 336}• Testosterone 59.06 pg/ml {30.1 – 142.5, males, not

on tx}

• DHEA-S 128.0 ug/dL {“25 – 240”; optimal more like 350 – 500}

• Testosterone 820 ng/dL {250 – 1100}• Free T 87.7 pg/ml {35.0 – 155.0}• IGF-1 81 mg/ml(L) {“91 – 246”}• TSH 1.20 uIU/ml {0.40 – 4.50• Free T4 1.7 mg/ml {0.8 – 1.8}• Free T3 303 pg/ml {230 – 420}• Reverse T3 44 (H!) ng/dL {11 – 32}

DHEA – the critical hormone most conventional doctors never check

• Produced in the adrenal cortex– Humans and primates are unique in secreting large

amounts – “the most abundant steroid hormone in the human body.” (Maninger et al. Front. Neuroendocrinol. 2009 Jan; 30(1):65-91.)

• Immune system booster; Insulin regulator• Energy increase – remarkable• Boosts growth hormone

– 20% in men; 30% in women in one study• [Yen, Morales Khorram – one year double-blind placebo

controlled crossover experiment – with 100mg DHEA]

• Antidepressant effects

349 citations on “DHEA with energy” – as of of 10/3/2012

Manninger, N et al. Neurobiological & neuropsychiatric effects of DHEA and DHEA-Sulfate. Front. Neuroendocrinol. 2009 Jan;30(1):65-91.

From secretory vesicles

DHEA – other interesting points• No nuclear receptor for DHEA or DHEA-S ever found;

mechanisms of action are not fully understood• Some actions may be through conversion into more potent sex

steroids and activation of androgen or estrogen receptors in tissue.

• May have effects through intermediate metabolites.• Neural growth (from animal studies)

– DHEA – increases axon length– DHEA-S – stimulated dendrite growth.

• DHEA-S promoted survival of adult human cortical brain tissue in vitro. – DHEA increased neurogenesis in addition to neuronal survival

Manninger, N et al. Neurobiological & neuropsychiatric effects of DHEA and DHEA-Sulfate. Front. Neuroendocrinol. 2009 Jan;30(1):65-91.

DHEA has been correlated with lower susceptibility to anxiety and mood disturbance.

Other indices: ACT scores, # of college classes dropped or failed, current GPA

Behavioral task – series of anagram puzzles from possible to IMPOSSIBLE.

Higher DHEA: cortisol ratio associated with “lowest probability of failing the task.”

Displacement activities (DA’s) screened for by video recording during tests.

91 students ½ male, ½ female – taking Organic Chemistry in the USA.

A logistical model built on GPA, DA’s, and salivary hormone levels of cortisol and DHEA correctly predicted 90% of the students who passed the class.

Treatment for the Stressed Executive

• Empirically started at ¼ grain Armour with increase to ½ grain at first appt (based on previous thyroid tests)– This was continued at next appt per labs.

• Start on DHEA 25 mg extended release tablets, then increase to 2– 3 tablets as needed and as tolerated. (Ultimately increased to 100 mg SR per day)

• High potency MVI with high dose B, C, minerals.

Five month follow-up• “I think all the stuff is working. My energy

level is good. If there’s anything lingering –it’s just stress from work stuff. I actually feel pretty good.”

• “0 – 10 energy scale” probe:– 24 – 25 yoa – maximum energy “10”– July 2011 (before labs and interventions) – “4”– October 2011 – “5 – 6”– January 2012 – “8”

July 2011 Nov 2011 Dec 29, 2012

Interventions 100 mg DHEA SR½ grain Armour

100 mg DHEA SR½ grain Armour1 pump T to each inner thigh

TSH 1.2 0.86 0.93

Free T4 1.7 1.5 1.3

Free T3 303 373 361

Rev T3 44 (H) 57 (H) 39 (H)

DHEA-S 128 472 (“H”) 306 (“H”)

IGF-1 81 106 120

Total testosterone 820 913 969

Free Testosterone 87.7 131.5 100.8

Other than fatigue, what’s the relevance?

DeKloet.Anna NY Acad. Sci. 1018:1-15(2004)

• Excess corticosteroid = catabolic consequences and “breakdown of vital functions.”

• Review of classical depression = hypercortisolism

• “Atypical depression” – hypocortisolism

• Association of high cortisol and psychotic depression

http://www.people.vcu.edu/~mreimers/SysNeuro/de%20Kloet%20-%20HPA%20review.pdf

Saliva or blood?• Saliva:

– 4 cortisols give rhythm, plus:• Average x 4 of:

– DHEA, testosterone, estradiol, and progesterone

– Much easier to obtain

– Early a.m. cortisol arguably more accurate.

– 4 lab values in a day averaged arguably more accurate

– Cheaper if cash pay

– Perfectly acceptable as a screening tool.

Downside: Apparent “disconnect” between post-treatment levels and salivary measurements

• Blood testing:– More published literature

targeting specific blood levels of sex hormones and DHEA (S)

– More predictable dosing of hormones with assiduous blood monitoring.

• Downsides – woefully skewed a.m. cortisol– Less likely to get 4 cortisols

One destigmatizing notion:Estrogen as MAOI

• Estrogen & Testosterone (!) decrease MAO– Luin, VN. Effect of gonadal steroids on

activities of MAO and choline acetylase in rat brain. Brain Res. 1975;86:273-306

• Platelet MAO levels inversely correlated to estradiol levels– Klaiber EL et al. Psychoneuroendo-

crinology. 1997 Oct;22(7):549-58.

• Estrogen decreases MAO-A & MAO-B– Holschneider DP et al. Life Sci. 1998;63(3):155-60

Estrogen: Good For Your Brain• Estradiol influences performances of learning and

memory tasks as well as increase working memory– Sub-point – women are living three decades longer;

hence they are spending more time hypoestrogenic– Pompilli A et al. Estrogens and memory in physiological and

neuropathological conditions. Psychoneuroendocrinology. 2012 Sept; 37 (9):1379-96

• Estradiol = protective against schizophrenia.– Kulkarni J, et al. Hormones and Schizophrenia. Curr Opin

Psychiatry. 2012 Mar;25(2):89-95

Testosterone: The “sexist” bias against women (e.g., “your loss of sex drive is just natural for

your age.”)

• Fall in the circulating testosterone and the adrenal preandrogens most closely parallel increasing age.

• Accelerated decrease occurs in the years preceding menopause (like estrogen).

• Their loss affects: libido, vasomotor symptoms (hot flashes), mood, well-being, bone structure, and muscle mass.– Burd, Bachmann. Androgen replacement in menopause.

Curr Womens Health Rep. 2001 Dec; 1(3):202-5.

Estrogen-related mood disorders – reproductive life cycle factors.

Douma SL et al. Adv. Nursing Sci. 2005. 28 (4):364-375

• “Clinical recovery from depression postpartum, perimenopause, and postmenopause through restoration of stable/optimal levels of estrogen has been noted.”

The Case of the Crying Cleaner• 1/11/12 - Symptoms:

– Crying/depressed = on Citalopram

– Hot flashes

– Night sweats

• RX:– Estradiol – 2 mg @HS

– Prometrium – 100 mg @HS

– (continue citalopram)

• 1/15/12 – RESOLVED• In 4 days!

Photo & data used with permission

Photo removed for internet slideshare and .pdf postings

• Decline in male sex steroids not as abrupt as menopause, but equally debilitating

–Between 40 – 70, average male loses:

• Nearly 2" of height

• 15% of bone density

• 10 – 20 pounds of muscle

•At 70 yoa, 15% completely impotent

Testosterone (Men)

November 2009 “Alpha Male” issue

Observational study of randomly selected men – Boston3 cohorts of men: 1987-1989; 1995-1997; 2002 -2004.1374, 906, and 489 men, respectively. “Age independent decline in T that does not appear to be attributable to observed changes in explanatory factors, including lifestyle characteristics such as smoking and obesity.”“Recent years have seen a SUBSTANTIAL, and as yet UNRECOGNIZED age-independent population-level decrease in T in American men.” Travison, Araujo, et al. Jrnl of Clin. Endocrinol & Metabol 92:1; 196-202.

Fast food (low Zn) is bad for you.

• Fast food = high energy density = low essential micronutrient density, ESPECIALLY ZINC

• Antioxidant processes are dependent on Zinc• Fast food = severe decrease in antioxidant

vitamins and zinc, correlating with inflammation in testicular tissue – with underdevelopment of testicular tissue and decreased testosterone levels

Prevalence of Low Total Testosterone

• 12% for men in 50s• 19% for men in 60’s• 28% for men 70s• 49% for men >80

Harman SM, Metter EJ, Tobin JD, Pearson J, Blackman MR. Longitudinal effects of ageing on serum total and free testosterone levels in healthy men. Baltimore Longitudinal Study of Aging. J Clin Endocrinol Metab 2001; 86(2): 724-31.

T vs Cognitive Function

Rosario ER. Age-related testosterone depletion and the development of Alzhiemer disease. JAMA. 292(2004):1431-2

T vs. Cognitive Function• 400 independently living men, 40-80yo

– 100 in each age decade– MMSE 21-30, average 28– TT: 208-1141ng/dL; Bio-avail T 78-470ng/dL

• HIGHER T = better cognitive performance in OLDEST AGE category

• Men with lowest 1/5 T = worse than men with highest 1/5 T

• Highest Bio-available T more significant than TT, age, intelligence level, mood, smoking, and alcohol.

Muller M, et al. Neurology. 2005 Mar;64(5): 866-71

T vs. Mood in men

• Study: 278 men, >45yo, followed 2 years

• Compared to eugonadal patients, hypogonadal men w/TT <200ng/dL had – 4-fold increase risk of depression– Significantly shorter time to depression

diagnosis

• Depression risk inversely related to TT w/statistical significance <280ng/dL

Shores MM, Arch Gen Psychiatry. 61(2004):162-7

Testosterone appears to be good for guys.

• Serum T, DHT and E(2) displayed no decrease associated with age among men over 40 years of age who self-report very good or excellent health– Sartorius G, et al. Serum testosterone, dihydrotestosterone and

estradiol concentrations in older men self-reporting very good health: the healthy man study. Clin Endocrinol (Oxf). 2012 Nov; 77(5):755-63

T vs. Heart Disease

• Men with CAD have significantly LOWER levels of androgens than normal controls.– English, KM et al. Men with coronary artery disease have lower

levels of androgens than men with normal coronary angiograms. Eur Heart J. 2000 June; 21(11):890-4.

• “There is early evidence from non-randomized studies that physiological testosterone replacement is extremely safe and may reduce cardiovascular mortality.”– Hackett G. Testosterone and the heart. Int J Clin Pract. 2012

July;66(7):648-55.

Relevance of testosterone (and DHEA + Thyroid)

RX: dairy free diet (+IgG test); D3 5000 IU/d; Armour thyroid, Testosterone cypionate 100 mg IM q wk, MVI, Zinc, DHEA 50 mg SR, CoQ10 400mg (permission granted to use photos & data)

Photos removed for internet slideshare and .pdf postings

Testosterone appears to be seriously good for guys’ brains

• “Results from cell culture and animal studies provide convincing evidence that testosterone could have protective effects on brain function.”

• “Testosterone levels are lower in Alzheimer’s cases compared to controls, and some studies have suggested that low free testosterone (FT) may precede AD onset.”

• “Positive associations have been found between testosterone levels and global cognition, memory, executive functions and spatial performance in observational studies.”

Holland J, et al. Testosterone levels and cognition in elderly men: a review. Maturitas. 2011 Aug; 69(4):322-37.

Testosterone and “Prostate Cancer risk”

• Prostate CA found 2.15 & 2.26 times more likely in lowest compared to highest tertile of total and free testosterone

• “. . . there are several papers showing a relationship between LOW testosterone and prostate cancer. Specifically, low testosterone has been associated with high-grade tumors, advanced stage of presentation, and worse prognosis.”

Morgentaler A. Eur Urol. 50(2006):935-9

Morgentaler A. Urology. 68(2006):1263-7

Benefits (and minimal risk) of testosterone – J Sex Med Sep 2012

Risks of Low T:•Reduced longevity•Fatal Cardiovascular events•Obesity•Sarcopenia•Mobility limits•Osteoporosis•Frailty•Cognitive impairment

•Depression•Sleep Apnea Syndrome

Risks of TX:•“There is no compelling evidence that Testosterone therapy causes prostate cancer or its progression in men.”

Conclusions: men with sexual dysfunction, visceral obesity, and metabolic diseases should be screened for testosterone deficiency and treated. Young men with TD should also be treated.

Buvat J et al. Testosterone deficiency in men: Systematic Review. J Sex Med. 2012 Sep 12

The Case of the Mismanaged Executive - summary

• 42 year old male ADHD CEO. Background in psychology. Now EXTREMELY stressed.

• “So tired I feel like I’m dying.” “Depressed.”• Lab findings – low testosterone, despite multiple pumps

daily of low potency FDA-approved “BigPharma” transdermal testosterone gel managed by endocrinologist

• Low thyroid. Low DHEA.• RX: Testosterone cypionate IM – 60 mg twice weekly.

DHEA – 50 mg SR. Armour thyroid – ½ grain.

• Clinical status: total resolution of symptoms in 3- 4 weeks. No antidepressant used.

What if we could just look at neurotransmitters like they would on Star Trek ?

Cell rate

Low estrogen, DHEA, cortisol, and low NT’s – putting it all together 52 yo woman, s/p TAH with fatigue and depression

Hormone Value norms

Cortisols All barely above pathological

various

DHEA 47.66 {106-300}

Estradiol (E2) <1.00 {1.0 – 3.2 = post menopausal}

Testosterone 8.44 {6.1 – 49 – female}

REFERENCES: Hormones in the body; neurotransmitters in the head – & pee

• Evaluation of a novel ELISA for serotonin: urinary serotonin as a potential biomarker for depression.– Nichkova MI et al. Anal Bioanal Chem. 2012 Feb;402(4):1593-600.

• Neurotransmitters excreted in the urine as biomarkers of nervous system activity: validity and clinical applicability.– Marc DT et al. Neurosci Biobehav Rev. 2011 Jan;35(3):635-44.

• Novel ELISAs for screening of the biogenic amines GABA, glycine, beta-phenylethylamine, agmatine, and taurine using one derivatization procedure of whole urine samples.– Hulsman H et al. Anal Chem. 2010 Aug 1;82(15):6526-33.

• Not a new technology. Already used for diphenhydramine, zolpidem, nicotine, amphetamines, methamphetamine, 5HIAA, prostaglandin E2, numerous others.

So what the heck am I supposed to do with this stuff?

“It’s really not that complicated!”

Behaviors/status Interventions

stress Job/life stress Meditation, spiritual practice, T’ai chi, Qigong, make needed life changes

Abnormal hormones

Presumptively low or unknown

Get levels – saliva or blood (pre-treatment)Check Neurotransmitters (urine ELISA)

Thyroid

DHEA

Interventions Optimize/support cortisol

Testosterone, Estradiol & Progesterone

Growth hormone?

Amino acid precursor loading for NT’s?

Prescriptive agents – e.g., anti-depressants, neurostimulants, etc.

How obvious does it have to be?

Ron Hunt lost an eye but suffered no brain damage after a freak accident with a large drill bit. (ABCNEWS.com)

LET’S START CHECKING THOSE LEVELS!

Contact information:

Louis B. Cady, M.D.

www.cadywellness.comwww.facebook.com/cadywellness

www.indianaTMS-cadywellness.com

Office: 812-429-0772E-mail: lcady@cadywellness.com

4727 Rosebud Lane – Suite FInterstate Office Park

Newburgh, IN 47630 (USA)

@LouisCadyMD@TMS4depression

Once more…. Where to “get the slides” -

www.slideshare.net/lcadymd

www.cadywellness.com/ammg/hormones.ppt

“Sit down before fact as a little child, be prepared to give up every preconceived notion, follow humbly wherever … nature leads, or you shall learn nothing.”- Thomas H. Huxley