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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by bleauberry on March 6, 2020, at 21:09:30
Way back a couple decades here, there was a short term fad of combining 50mg of Naltrexone with Prozac for two reasons, 1.It worked for treatment resistance. 2.It resisted poop out. If I remember correctly, it was a long time ago, results were mixed in about the same way as any other cocktails. It was difficult to get to 50mg because an early side effect is nausea. All of us started with just crumbs and worked up over a couple weeks. My response was neutral.
Fast forward to today. A common treatment prescribed by Functional Medicine M.D.s and Lyme Literate M.D.s is Low Dose Naltrexone, or LDN for short. It's effects are anti-depressant and anti-pain and anti-fatigue.
Long story short on its mechanism. The theory is that the low dose of just 1.5mg to 4.5mg is taken at bedtime and temporarily blocks our natural opioid receptors for a few hours. That tricks the feedback loops into manufacturing more opioids. Over several weeks the natural opioid levels in the body build up and increase, improving mood, pain and energy.
But the thing that struck me was that after a couple decades, Naltrexone is back in the game again and might be worth trying it for a month or two. It requires a compounding pharmacy to make those tiny doses.
My own experience was that during a whole month long trial there was one magical day where I felt like my old self and I thought it was a miracle and it was amazing. And it was just one day. It never happened again. So I eventually dropped it.
Theory says that it works best with serotonin based antidepressants. But I would think its mechanism can blend favorably with a wide variety of psych meds.
So it was a thing a couple decades ago at 50mg in the world of antidepressants. It's a thing again today at just 1.5mg-4.5mg in the world of antidepressants.
LDN is prescribed in the treatment of lyme, chronic fatigue syndrome, fibromyalgia, lupus, multiple sclerosis, depression, anxiety. Its mechanism is to increase the body's natural opioid levels, which regulates the immune system in a positive way, and it also has interaction with dopamine and serotonin circuits.
Anyway, I just thought it was interesting how Naltrexone has evolved over the years.
Posted by linkadge on March 7, 2020, at 6:08:40
In reply to Revisiting Naltrexone for Depression, posted by bleauberry on March 6, 2020, at 21:09:30
Naltrexone is also a potent kappa opioid antagonist. Activation of kappa receptors causes dysphoria. Stress increases dynorphin which activates the kappa opioid receptors which leads to diminished dopamine release. Dynorphin is also increased by chronic drug / alcohol abuse.
Anyhow, naltrexone may be working (in part) via this mechanism.
Linkadge
Posted by undopaminergic on March 7, 2020, at 9:39:20
In reply to Re: Revisiting Naltrexone for Depression, posted by linkadge on March 7, 2020, at 6:08:40
> Naltrexone is also a potent kappa opioid antagonist.
Right, and so is buprenorphine (Subutex, Suboxone, Temgesic, Buprenex). In combination with methylphenidate (Concerta), it (Temgesic) was the best combination I've ever been on, and I only stopped it because they stopped prescribing.
> Activation of kappa receptors causes dysphoria. Stress increases dynorphin which activates the kappa opioid receptors which leads to diminished dopamine release. Dynorphin is also increased by chronic drug / alcohol abuse.
>Yes, and in addition, it seems to be one of the mechanisms causing tolerance to stimulants, at least cocaine, but probably methylphenidate too. I'm not sure, but I wouldn't be surprised if it (dynorphin) is also involved in tolerance to other drugs.
-undopaminergic
Posted by Lamdage22 on March 8, 2020, at 4:53:50
In reply to Revisiting Naltrexone for Depression, posted by bleauberry on March 6, 2020, at 21:09:30
I was too impatient and a little bit scared. I took it for 3 weeks.
Posted by Hugh on March 8, 2020, at 15:36:09
In reply to Revisiting Naltrexone for Depression, posted by bleauberry on March 6, 2020, at 21:09:30
You don't need to go to a compounding pharmacy for low-dose naltrexone. Just take a 50 mg tablet of naltrexone and drop it into 50 ml of distilled water. After 30 minutes, stir it thoroughly, and you're all set with liquid LDN. It will keep in the refrigerator for over a month. Start with a dose of 1 mg, taken at bedtime. Increase your dose gradually over the next several weeks. The maximum dose of LDN is 4.5 mg.
If low-dose naltrexone doesn't have the desired effect on you, it might be worth your while to try an even lower dose of it. If that doesn't help, then go even lower. In fact, the lower the dose of naltrexone, the more effective it might be. The following quote is from
"Cotreatment with ultra-low-dose naltrexone at 16.7, 20, or 25 ng/kg, but not at 10 or 200 ng/kg, induced a significant CPP after this 2-h delay. This finding implies that, whereas the rewarding effects of morphine have dissipated by 120 min postinjection, ultra-low-dose naltrexone may extend this effect."
In other words, an extremely low dose of naltrexone enhanced the effects of morphine, and prevented tolerance to it from developing. And it prevented dependence and addiction from developing. A higher, but still tiny, dose of naltrexone didn't have these beneficial effects.
Even if you're not taking opioids, you might benefit from taking ultra-low-dose naltrexone, since we all have naturally occurring opioids -- endorphins. An extremely low dose of naltrexone, taken every day, might improve your brain's response to your naturally occurring endorphins.
So if you aren't helped by 1.5 to 4.5 milligrams of naltrexone, try lowering your dose to micrograms. If that doesn't help, lower your dose to nanograms. If that doesn't help, lower it to picograms. Other than the naltrexone, all you need is distilled water to dilute it with and a calculator.
Posted by Hugh on March 8, 2020, at 16:00:42
In reply to Re: Revisiting Naltrexone for Depression, posted by Hugh on March 8, 2020, at 15:36:09
Use this to make and store liquid LDN:
https://www.amazon.com/Anchor-Hocking-5-Ounce-Measuring-Glass/dp/B001QYAGO4
Use this to measure a dose of liquid LDN:
https://www.amazon.com/Apex-60505-Dual-Dropper-Kit/dp/B004ZBH02G
Liquid LDN is bitter, so you might want to mix a dose with a little water or juice.
Posted by undopaminergic on March 8, 2020, at 16:38:33
In reply to Re: Revisiting Naltrexone for Depression, posted by Hugh on March 8, 2020, at 15:36:09
Sounds amazing!
I'd be interesting in trying this some time.
-undopaminergic
Posted by jay2112 on March 9, 2020, at 20:20:11
In reply to Re: Revisiting Naltrexone for Depression, posted by linkadge on March 7, 2020, at 6:08:40
Suboxone, a combo of naltrexone and buprenorphine, (used for recovering opioid addiction) is one of a few excellent meds I use for depression/anxiety...as well as cannabis and the only prescription med that does anything for me as well..Lyrica/pregabalin.
Jay
Posted by undopaminergic on March 10, 2020, at 11:35:31
In reply to Re: Revisiting Naltrexone for Depression, posted by jay2112 on March 9, 2020, at 20:20:11
> Suboxone, a combo of naltrexone and buprenorphine, ...
Naloxone. It has the same mechanism of action, but I think it has a shorter duration.
-undopaminergic
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