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Re: Refractory depression--naltrexone

Posted by Jim on April 17, 1999, at 12:35:50

In reply to Re: Refractory depression--naltrexone, posted by Elizabeth on April 17, 1999, at 9:33:06


Thanks for the support--it's been a wild week and I'm still waiting to see how things settle down if & when I can get a stable regimen going. As you might have heard, I cut short my first try with naltrexone augmentation after about 3 days. I had started with miniscule doses (around 5mg/day) given my general supersensitivity to meds, but even this proved too much--by the morning of day 3 I had some very serious dysphoria going and threw in the towel. Surprisingly, it was about three or four days LATER that I began to feel curiously better, though given my general mood lability II didn't make much of a connection at the time, especially as I had read that naltrexone's half-life was about 10 hours. (Turns out this is perhaps not entirely true--see below.)

Anyhow, I started again with still lower (!) doses last weekend--we're talking tiny chips, perhaps 2 or 3mg--and noticed a positive effect within hours. (I also added a speck of klonopin nightly at bedtime.) By mid-week, I felt an antidepressant effect truly unlike any I had ever felt before--alas, it was a bit *too* intense, if anything, and I find myself now trying to get things to level off a bit. (My response wasn't hypomanic, more of an excited Rip-Van-Winkle-like strangeness overlaid by surface calm...) What I've found out in my copious web research over the last few days is that naltrexone may have an effective half-life of far more than 10 hours, which may somewhat explain the unexpected dynamics.

In any case, I'm in an expectant wait-and-see mode right now. Like Wayne before me, I feel this has at least the *potential* to change my quality of life completely, but I'll need to figure out the dosage issues and do a lot of readjusting to get to that point. FYI, I am probably best categorized as a long-term "refractory dysthymic", with atypical depressive features, a touch of OCD, and serious food cravings. Personally, I am surprised that naltrexone is not yet being more widely used as an adjunctive therapy in refractory depression--I will echo Wayne in highly recommending the material from Dr. Lee Dante and others in the "tips" section of this site. Your positive reaction to Buprenorphine may be all the more reason to try an antagonist strategy that might actually get closer to the root of things.

Thanks again and best of luck back to you. I'll try to keep the list posted with my results. (And by the way, when I tried Prozac for a while I used to take less than 1/2 mg!)
Elizabeth wrote:
> ... Could you describe in more detail your reaction to the 25mg dose of naltrexone? I'm curious because you compared it to your response to SSRIs - some folks with panic disorder experience an "activation syndrome" if they start on normal doses of an SSRI (they have to start out at, say, 5mg of fluoxetine), and I'm wondering if this might be the same thing. (Dunno if this happens with other anxiety disorders.) (Did you try the start low/go slow strategy with SSRIs?)
> BTW what are your diagnosis (-es?) and predominant symptoms?
> I'm interested in particular because while I had a phenomenal response to buprenorphine, the side effects were just too much. (I'd hoped it would be better than morphine, but no such luck.) So I'm going back to Parnate, augmenting with lithium and possibly a tricyclic. I don't have impulse-control problems (eating disorders, substance abuse, self-injury, etc.) or poop-out issues (with Parnate, anyway) so I'm not sure if naltrexone would be right for me, but it would be useful to get a better idea of when it works for other people.
> Best of luck to you.




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