Psycho-Babble Medication | about biological treatments | Framed
This thread | Show all | Post follow-up | Start new thread | List of forums | Search | FAQ

Re: Atypical depression...

Posted by Wayne R. on March 7, 1999, at 16:44:32

In reply to Re: Atypical depression..., posted by MA on March 7, 1999, at 11:34:46

> Wayne, is there any information on why this works? I mentioned this to my doctor and he hadn't heard of Naltrexone used to augment SSRI's.
I have attached one of the items that got me to insist on trying Naltrexone. I recently got a letter from Dr Dante noting that he has used it successfully with several hundred patients at this point. He stated that WHY it works is still not known...

From: Dr. Lee Dante
Subject: Augmentation of clomipramine with naltrexone

I began using naltrexone clinically a number of years ago. I had long felt that the opiate system was a major player in depression but needed a way of intervening that didn't run the risk of inducing addiction. (Virtually all partial agonists have caused addiction problems and only naltrexone, the pure antagonist, has shown no addictive potential or significant morbidity after almost two decades of clinical use.) After twenty five years of seeing psychiatric patients I have had many patients referred to me who suffer from intractable depressions.

One woman in her twenties had been under my care for three years. She had been hospitalized three times before I got her. She had an eating disorder, had tried suicide, and had in the past done "delicate slicing". She had unremitting depression only weakly responsive to MAOIs, every TCA at therapeutic doses, ECT, fluoxetine, sertraline, and clomipramine. Trazodone, augmentation with lithium, and thyroid were not helpful. She had no relief from trials of anticonvulsant medications. As often happens with the chronically ill she disappeared for a year. When she returned she began by saying,"Doc, could you give me the Anafranil (clomipramine) again (200 mg)? Nothing will ever cure my depression but at least I could sleep." I agreed but asked her if she would try another augmentation strategy. I explained that the approach was not even remotely standard practice, etc. She answered with a shrug.

Four weeks after I added 25 mg of naltrexone at bedtime she phoned me. "Doc, I was playing badminton with my family and I suddenly realized that I was having fun! I have never felt that before!" If I stopped either medicine she would start to relapse. Two years later she was still depression free and engaged.

I have learned through bitter experience to believe only results. This was no placebo response. Neither one of us really expected her to do so well having been down the augmentation trail together many times. I knew after this experience that the question was not *if* this was worthwhile but rather *in whom*.

Although the next handful of patients were similarly desperate cases, I no longer restrict the use of this strategy to the "last chance" scenario. In fact, I've done this now with well over fifty of my patients.




Post a new follow-up

Your message only Include above post

Notify the administrators

They will then review this post with the posting guidelines in mind.

To contact them about something other than this post, please use this form instead.


Start a new thread

Google www
Search options and examples
[amazon] for

This thread | Show all | Post follow-up | Start new thread | FAQ
Psycho-Babble Medication | Framed

poster:Wayne R. thread:3449