Question for CycloTrpTyr

This question is for Cyclo but anyone with ideas or experiences is asked to comment.

I need to find a very potent Anxiolytic for everyday long-term use. This is for someone with extreme Cortisol levels (3-4 times the normal range). What are the best options to look at? Also, how can I effectively upregulate the GABA-a receptor?

Howdy, Will have to do some serious reading up on this one.

The problem with anxiolytics is that they are very addictive. So youll be substituting one problem for another and then add, on top, of that a potential of inability to cope without them as well. I.e. psychological and physical dependence.

We all know the effects of cortisol and that the main cause of it is stress. Thus the most obvious course of action is to try and reduce the cortisol levels.

BUT - easier said than done. What or why is the cortisol high? Is it endocrinological/physical or environmental?

The cortisol has been that high for many years actually. This is a very calm and in-control person (not a drama fairy). For me the most concerning is why these levels are so high for so long. The dude doesn't use corticosteroids often so that leaves with few other very disturbing causes. No need to go through too much trouble. I was hoping you are an old hand at this and might have some good insights for me.

What do you think about beta-blockers, especially for someone with a bodybuilding lifestyle?

Ok, a few questions. I can assume there is no underlying depression as you say they are calm in in-control (although some people have developed unbelievable defense/self preservation mechanisms - NB not the same as denial)

Do they exhibit Cushing's symptoms like puffines, water retention etc?

Has Cushing's Syndrome been excluded?

Iatrogenic Cushing's? i.e. Is the person on chronic cortisone therapy for e.g. asthma or rheumatoid arthritis.

Liver or kidney issues? Thyroid (don't need to tell you anything about that).

Do they get enough sleep, i.e. they're not a stockbroker working 20 hours a day day in and day out.

Otherwise, the person may just have what we perceive as "high" levels but it may be perfect for them. Those levels are a "global" average and some people fall outside those values.

As for the Beta blockers with a "bodybuilding" lifestyle. What is the indication for the Beta blocker. If it is to manage BP and reduce cardiac contractility (afterload) it shouldn't be a problem, just bear in mind that with intense cardio or exercise which raises the HR it may be insufficient leading to a drop in performance.
Bisoprolol and Atenolol are the most commonly used one because old ones like Propanolol have a bevy of side effects. They are quite good in that they allow the heart to "speed" up when required.

But in all aspects where beta blockers are used there are newer drugs in other classes that are superior (imho).
Obviously if you're on a beta blocker Clen is a big no no

He did 3 Total Cortisol blood tests yesterday.
1) 8am fasted (slightly higher than ref range)
2) 2pm (highish)
3) 10pm before bed (on the low side)

Therefore definately not Cushing's syndrome (thank the pope).. He doesn't use chronic Corticosteroids like I said. Liver, kidney and thyroid are very healthy and he gets plenty of sleep.

Just wanna say thank you many times for your trouble I appreciate it!