Chris mentions ‘We refer to stress-induced pathology as HPA dysfunction, but the reality is that stressors affect us via two primary mechanisms: the HPA axis and the SAS. I understand that these are intertwined, but my question is, isn’t it rather important to try to work out which one is dominant, or which one of these is dominantly out of whack in certain situations like waking up in the middle of the night because the physiology will be a bit different? If cortisol is too high at night, isn’t that really different than if adrenaline is high at night? I know the long-term solutions will be the same, but in the short term in terms of which supplements to use, etc.

Dr. Amy Nett: You know, I mean, it’s a good question, and I think there are probably definitely some nuanced differences between the HPA axis dysregulation and the SAS responses, sympathoadrenal stimulation, but I don’t think that the management, even in the short term, is really going to be different here. Again, what you’re really looking at here is how to decrease that stress response because even HPA axis dysregulation—if you have a high cortisol or an elevated stress response, you’re going to potentially be seeing elevations both in cortisol and also adrenaline or epinephrine. I don’t even know that I would know how you can more specifically differentiate. I think it’s certainly worth understanding what cortisol looks like because you always have to consider what the clinical picture looks like and what the lab picture looks like. As you saw in this week’s treatment protocols, treatment is going to be very—well, it’s going to be at least somewhat different if a patient has a subjective experience of a hypercortisol state but normal cortisol in testing, whereas we’re probably going to have more flexibility in terms of treatment options if a patient has both elevated cortisol on testing and also symptoms of elevated cortisol. So, I think, either way if you’re showing symptoms, hyperarousal, high anxiety, high stress states, you need to treat it as such. I’m not even sure how you would tease out exactly the difference between HPA axis and SAS response, but they’re both really going to be focusing on how to sort of decrease that stress response.