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Louis B. Cady, MD – CEO & Founder – Cady Wellness Institute  Adjunct Professor – University of Southern Indiana Adjunct Clinical Lecturer – Indiana University School of Medicine Department of Psychiatry Child, Adolescent, Adult & Forensic Psychiatry – Evansville, Indiana Mental Health and Hormones: What in the World do Hormones Have to Do with Current Allopathic Psychiatry? This presentation is © Louis B. Cady M.D. and may not be reproduced or used without permission.  World Link Medical is authorized to reprint/duplicate it for 2012 syllabi. (c) 2012 Louis B. Cady, M.D. - all rights reserved
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BODY MIND ACTIONS
Critical area of concern for men & women.  Things that will make them: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
A Shrink meets the  “anti-aging” crowd ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Interesting lab values – Cady – 3/11/03: Lab Value Cenegenics Normal a.m.glucose 87 mg/dl 65 – 85 65 – 109 Fasting insulin 3 u U/ml <5 <20 HgB A1C 4.9 % <5.1% < 6.0 % Cholesterol 241 mg/dl <200 <200 Triglycerides 42 mg/dl <120 <150 Cor. Risk ratio 3.3 <4.0 Av = 5 – 6 Homocysteine 7.9 <8.0 5.4-11.4 DHEA-S 148 350 – 500 59 – 452
4
Releasing  Factors Adrenal Gland Ovaries Testicles Thyroid Liver Testosterone Estrogen Cortisol DHEA Progesterone T3  &  T4 GH LH & FSH TSH Prolactin ACTH IGF-1 Pituitary Brain Hypothalamus DHEA
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Useful Target Symptoms in MDD 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.
“ But the doctor told me my thyroid was fine.” ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
“ the foot soldier” “ the evil twin ”
“ Thyrotropin (Thyroid-Stimulating Hormone or TSH).  Measuring TSH is the most sensitive indicator of hypothyroidism. ”  (hunh?!) http://www.umm.edu/patiented/articles/how_serious_hypothyroidism_000038_6.htm Accessed: 9/5/2011
“ the foot soldier” “ the evil twin ” CORTISOL Se
Yes, T-3 DOES get into the brain  (Transthyretin = carrier protein ) ,[object Object],[object Object],[object Object],[object Object],[object Object],Or: The idiocy of T4 only thyroid treatment…
Transthyretin (a systemic amyloid precursor) may be protective for Alzheimer’s  (Why?) Li X et al.  J Neurosci 2011 Aug 31;31(55):12483-90
Per HDRS – 17, remission in: 15.9% on Li 24.7% on T3 Per QIDS-SR16, remission in: 13.2% on Li 24.7% for T3 * * Fava & Covino: Augmentation/Combination Therapy in STAR*D Trial, Medscape Psychiatry LEVEL III RESULTS:
Fatigue from Adrenal Dysfunction -  The Worst Case Scensario:  Addison ’s Disease
“ Hypoadrenia” : The Adrenal Problem that most conventionally trained physicians don’t know about. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Modern medicine does not recognize it.
The state of adrenal exhaustion can be determined Early-stage Chronic Stress Response Mid-stage Chronic Stress Response End-stage (exhausted) Chronic Stress Response
DHEA – the critical hormone most doctors never check ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
334  citations on  “DHEA with energy” – as of 07 29 2011
Why isn ’t adrenal fatigue diagnosed? ,[object Object],[object Object],[object Object],[object Object],[object Object]
Neurobiological & neuropsychiatric effects of DHEA & DHEAS  [Maninger N et al. Front Neuroendocrinology 2009] ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
“ Women’s issues”
The Glamorous Grandmother ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
G.G.  - interventions 5/2/11 & Follow-up  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
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
The glamorous grandmother – post tune-up 9/28/2011  (permission granted to use photos & data) 01/26/2012 Pictures removed for publicly posted slide deck
One destigmatizing notion: Estrogen as MAOI ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Estrogen-related mood disorders – reproductive life cycle factors.    Douma SL et al.  Adv. Nursing Sci. 2005.  28 (4):364-375 ,[object Object]
Symptoms of estrogen imbalances*:  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],* Adapted from Whitney Gabhart, N.D.
The Case of the Crying Cleaner ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Photo & data used with permission Picture removed for publicly posted slide deck
Psychoactive Progesterone* ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],* Adapted from Whitney Gabhart, N.D.
Testosterone: The “sexist” bias against women (e.g., “your loss of sex drive is just natural for your age.”) ,[object Object],[object Object],[object Object],[object Object]
The Case of “Pajama Mama” ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
The Case of “Pajama Mama” - treatment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
The Case of “Pajama Mama” – lab review ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
This is what those labs “sound like” ,[object Object],[object Object],[object Object]
Pajama Mama – treatment and follow-up ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
PJ Mama – STABLE – 1/17/2012 ,[object Object],[object Object],[object Object]
 
Fast food (low Zn) is bad for you. ,[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Testosterone (Men)
T vs Cognitive Function Rosario ER.  JAMA . 292(2004):1431-2
T vs Cognitive Function ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Muller M.  Neurology . 64(2005):866-71
T vs Mood in men ,[object Object],[object Object],[object Object],[object Object],[object Object],Shores MM,  Arch Gen Psychiatry . 61(2004):162-7
Testosterone and “Prostate Cancer risk” ,[object Object],[object Object],Morgentaler A.  Eur Urol . 50(2006):935-9 Morgentaler A.  Urology . 68(2006):1263-7
The Case of the Mismanaged Executive - summary ,[object Object],[object Object],[object Object],[object Object],[object Object]
A synthesis… ,[object Object]
50’ish year old female, post-menopausal, on no hormones ,[object Object],[object Object],[object Object],[object Object],[object Object]
 
 
 
 
Treatment for this “normal” patient ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
What’s life like now? ,[object Object],[object Object],[object Object],[object Object],[object Object]
Key points ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
HOW OBVIOUS DOES IT HAVE TO BE?    The Challenge of Empathic Listening  & CREATIVE THINKING Ron Hunt lost an eye but suffered no brain damage after a freak accident with a large drill bit. (ABCNEWS.com)
“ Sit down before fact as a little child,  be prepared to give up every preconceived notion,  follow humbly wherever and to whatever abysses nature leads, or you shall learn nothing.” - Thomas H. Huxley
Contact information: Louis B. Cady, M.D. www.cadywellness.com   www.indianaTMS-cadywellness.com   Office: 812-429-0772 E-mail:  [email_address] 4727 Rosebud Lane – Suite F Interstate Office Park Newburgh, IN  47630  (USA)

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Mental health and hormones cady

  • 1. Louis B. Cady, MD – CEO & Founder – Cady Wellness Institute Adjunct Professor – University of Southern Indiana Adjunct Clinical Lecturer – Indiana University School of Medicine Department of Psychiatry Child, Adolescent, Adult & Forensic Psychiatry – Evansville, Indiana Mental Health and Hormones: What in the World do Hormones Have to Do with Current Allopathic Psychiatry? This presentation is © Louis B. Cady M.D. and may not be reproduced or used without permission. World Link Medical is authorized to reprint/duplicate it for 2012 syllabi. (c) 2012 Louis B. Cady, M.D. - all rights reserved
  • 2.
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  • 7. Interesting lab values – Cady – 3/11/03: Lab Value Cenegenics Normal a.m.glucose 87 mg/dl 65 – 85 65 – 109 Fasting insulin 3 u U/ml <5 <20 HgB A1C 4.9 % <5.1% < 6.0 % Cholesterol 241 mg/dl <200 <200 Triglycerides 42 mg/dl <120 <150 Cor. Risk ratio 3.3 <4.0 Av = 5 – 6 Homocysteine 7.9 <8.0 5.4-11.4 DHEA-S 148 350 – 500 59 – 452
  • 8. 4
  • 9. Releasing Factors Adrenal Gland Ovaries Testicles Thyroid Liver Testosterone Estrogen Cortisol DHEA Progesterone T3 & T4 GH LH & FSH TSH Prolactin ACTH IGF-1 Pituitary Brain Hypothalamus DHEA
  • 10.
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  • 12. “ the foot soldier” “ the evil twin ”
  • 13. “ Thyrotropin (Thyroid-Stimulating Hormone or TSH). Measuring TSH is the most sensitive indicator of hypothyroidism. ” (hunh?!) http://www.umm.edu/patiented/articles/how_serious_hypothyroidism_000038_6.htm Accessed: 9/5/2011
  • 14. “ the foot soldier” “ the evil twin ” CORTISOL Se
  • 15.
  • 16. Transthyretin (a systemic amyloid precursor) may be protective for Alzheimer’s (Why?) Li X et al. J Neurosci 2011 Aug 31;31(55):12483-90
  • 17. Per HDRS – 17, remission in: 15.9% on Li 24.7% on T3 Per QIDS-SR16, remission in: 13.2% on Li 24.7% for T3 * * Fava & Covino: Augmentation/Combination Therapy in STAR*D Trial, Medscape Psychiatry LEVEL III RESULTS:
  • 18. Fatigue from Adrenal Dysfunction - The Worst Case Scensario: Addison ’s Disease
  • 19.
  • 20. The state of adrenal exhaustion can be determined Early-stage Chronic Stress Response Mid-stage Chronic Stress Response End-stage (exhausted) Chronic Stress Response
  • 21.
  • 22. 334 citations on “DHEA with energy” – as of 07 29 2011
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  • 28. 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
  • 29. The glamorous grandmother – post tune-up 9/28/2011 (permission granted to use photos & data) 01/26/2012 Pictures removed for publicly posted slide deck
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  • 45. T vs Cognitive Function Rosario ER. JAMA . 292(2004):1431-2
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  • 60. HOW OBVIOUS DOES IT HAVE TO BE? The Challenge of Empathic Listening & CREATIVE THINKING Ron Hunt lost an eye but suffered no brain damage after a freak accident with a large drill bit. (ABCNEWS.com)
  • 61. “ Sit down before fact as a little child, be prepared to give up every preconceived notion, follow humbly wherever and to whatever abysses nature leads, or you shall learn nothing.” - Thomas H. Huxley
  • 62. Contact information: Louis B. Cady, M.D. www.cadywellness.com www.indianaTMS-cadywellness.com Office: 812-429-0772 E-mail: [email_address] 4727 Rosebud Lane – Suite F Interstate Office Park Newburgh, IN 47630 (USA)

Editor's Notes

  1. Depressed mood is the most commonly cited symptom in major depressive disorder. Studies have shown that fatigue and reduced energy are nearly as common as depressed mood. As many as 94%-97% of patients may experience reduced energy and fatigue, while 73% may complain of tiredness. Impaired concentration is also common and occurs in as many as 84% of patients. Hypersomnia, or excessive sleepiness as opposed to physical weariness, is less common and occurs in 10%-16% of patients.
  2. Addison ’s disease, like so many medical conditions, has a history of being ignored, hidden, and misunderstood.  It is a rare disease that affects about one in every 100,000 Americans and is usually diagnosed around age forty. 
  3. These symptoms correlate to decrease in bioavailable testosterone
  4. RIA (in-house after diethylether extraction) Total testosterone - T (RIA) 208-1141ng/dL, average 536+/-153ng/dL Bioavailable testosterone - BT (calculated) 78-470ng/dL, average 236+/-63ng/dL
  5. Hypogonadal if TT &lt; 200ng/dL or FT &lt; 0.9ng/dL