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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by SLS on May 1, 2001, at 19:34:37
Has anyone had success with naltrexone?
What drugs are good to combine it with?
Thanks in advance...
- Scott
Posted by JahL on May 1, 2001, at 19:45:14
In reply to Help. Does naltrexone (Revia) work for depression?, posted by SLS on May 1, 2001, at 19:34:37
> Has anyone had success with naltrexone?
>
> What drugs are good to combine it with?Prozac, apparently.
Being @ the 'try anything' stage, I'm about to try the combo.
Will report back. Science in action...
J
Posted by anita on May 1, 2001, at 19:52:21
In reply to Help. Does naltrexone (Revia) work for depression?, posted by SLS on May 1, 2001, at 19:34:37
Hey Scott,
According to Jay Goldstein's web page, naltrexone increases dopamine. Interesting, huh? I suppose it would be best to take it with an SSRI, since the claims of antidepressant value seem to be dependent on the co-administration of one. Personally, it made me kinda nauseous, but I only tried it once.
anita
> Has anyone had success with naltrexone?
>
> What drugs are good to combine it with?
>
> Thanks in advance...
>
>
> - Scott
Posted by Anna Laura on May 2, 2001, at 2:22:03
In reply to Help. Does naltrexone (Revia) work for depression?, posted by SLS on May 1, 2001, at 19:34:37
> Has anyone had success with naltrexone?
>
> What drugs are good to combine it with?
>
> Thanks in advance...
>
>
> - ScottHi Scott,
I found this article on the tips section: it's a success story with naltrexone. May be you'll find it interesting.....
Date: Fri, 06 Jun 1997 18:23:23 -0700
From: Lee Dante < ldante@pol.net >
Subject: Augmentation of clomipramine with naltrexoneI 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. (This woman had been terrified of men having watched her father beat her brother and mother to a pulp in regular alcoholic rages since she was just out of diapers.) I just got a card from this particular patient telling me that she was pregnant and happily married.
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.
Posted by JohnL on May 2, 2001, at 4:15:02
In reply to Help. Does naltrexone (Revia) work for depression?, posted by SLS on May 1, 2001, at 19:34:37
> Has anyone had success with naltrexone?
>
> What drugs are good to combine it with?
>
> Thanks in advance...
>
>
> - ScottThere was a fellow here quite some time ago (WayneR) who had phenomenal success with Naltrexone. At the time it encouraged some of us here to try it as well, though none of us who did had the remarkable response he did.
Apparently anecdotal evidence suggests it works best with SSRIs, but particularly Prozac.
My pdoc tried it experimentally with a few of his toughest cases, without success. As with all these drugs, it's a miracle for some and worthless for others.
John
Posted by Elizabeth on May 2, 2001, at 4:27:55
In reply to Re: Help. Does naltrexone (Revia) work for depression?, posted by anita on May 1, 2001, at 19:52:21
> According to Jay Goldstein's web page, naltrexone increases dopamine. Interesting, huh? I suppose it would be best to take it with an SSRI, since the claims of antidepressant value seem to be dependent on the co-administration of one. Personally, it made me kinda nauseous, but I only tried it once.
Nausea is a really common side effect of naltrexone. There is also the risk of worsened depression. It's supposed to help some people with dissociative symptoms, though.
The only success stories I've heard have involved the addition of naltrexone to an SSRI.
Posted by ChrisK on May 2, 2001, at 6:25:06
In reply to Help. Does naltrexone (Revia) work for depression?, posted by SLS on May 1, 2001, at 19:34:37
Check in the archives for posts from Wayne R. He had a lot of success with Naltrexone. I started taking it for the alcohol craving properties thatit is usually prescribed for. It did help as and AD adjunct. I took it in addition to a TCA so I knoww it can work with them as well as SSRI's.
> Has anyone had success with naltrexone?
>
> What drugs are good to combine it with?
>
> Thanks in advance...
>
>
> - Scott
Posted by SLS on May 4, 2001, at 8:46:56
In reply to Re: Help. Does naltrexone (Revia) work for depression?, posted by ChrisK on May 2, 2001, at 6:25:06
Thank you.
Posted by Fred Potter on May 6, 2001, at 16:35:51
In reply to Thank you. (np), posted by SLS on May 4, 2001, at 8:46:56
I tried 25mg Naltrexone with 40mg Prozac daily some weeks ago. It worked better than anything else I tried. I had to stop because it was so expensive. Since when I've got very bad again. So I've decided to stuff the cost and try it again. Well the first time it took only about 6 days for the unmistakable feeling of poop-out lifting. This time, with only 20mg Prozac, it took 17 and I was ready to give up on it. I hope it will last.
Can someone please explain how blocking your natural opiate receptors brings peace to an unquiet mind? If this is the reason it stops reinforcement in the alcohol effect, how is it that "healthy" ways of stimulating the same endorphins seem unaffected or even increased? Perhaps they're not the same natural opiates.
Is there down-regulation of natural opiate receptors (such as might happen with chronic alcohol administration) that is relieved by blocking them? Or can there be too many receptors?
Finally, is there any evidence that the augmentation strategy itself can poop out?
Thanks everyone
Fred
Posted by mila on May 7, 2001, at 3:17:06
In reply to Naltrexone success, posted by Fred Potter on May 6, 2001, at 16:35:51
Hi!
> Can someone please explain how blocking your natural opiate receptors brings peace to an unquiet mind?
Prozac brings peace to an unquiet mind (my guess)by lowering the hyper-reactivity of the threat system which otherwise can be dampened by alcohol. naltrexone increases social deprivation induced distress behavior and causes quicker neurological development. Administration of an opiate antagonist lowers hyperreactivity to painful stimuli, such as sexual deprivation, sensory overstimulation, frustration, disappointment, and involuntary social isolation)as well.
===how is it that "healthy" ways of stimulating the same endorphins seem unaffected or even increased?
I am not sure about 'the same' part of your question. Pleasure seeking activities are mediated mainly by the dopaminergic system. While Prozac brings serotonin concentration to normal or enhanced levels, which are associated wiht satiety, with relief from need for reward, with enhanced resistance to punishment, and with the ability to use threat cues to govern behavior, it leads to decrease in need for ethanol intake. It is my guess, that your dopaminergic system has been damaged or suppressed by the years of ethanol consumption, and freedom from alcohol disinhibits dopaminergic release. The subjective effects of increased levels of dopamine are analgesic, we experience them as hope, excitement, and curiosity. These feelings and dopamine release are triggered by promise, by cues of reward, and force us near what is potentially necessary to us. Associated pleasure, hope and curiosity are used as enticement by the dopaminergic system here.>
> Is there down-regulation of natural opiate receptors (such as might happen with chronic alcohol administration) that is relieved by blocking them? Or can there be too many receptors?
>
I have never heard of such down-regulation, but I am not an expert on ANY down-regulation either:). What seems to be happening is rather a natural process. There is a delicate balance of love-related deactivation and social-induced activation of pain circuitry. At first stages of isolation from the loved ones we experience distress. If contact is not reestablished in some variable critical time period, we cease protesting and withdraw. After such withdrawal we are often resistant to the reestablishment of close contact, as if our trust were broken. In extreme desperate cases we cease seeking non-specific contact and may die.The first stages of loneliness or grief produce a state of neuropharmacological affairs similar to that induced by opiate withdrawal in addicts. Prolonged isolation, by contrast, reverses the process, overwhelming the organism with endogenous opiates, restricting need for and affect of social contact. the proper amount of voluntary separation enhances development, while excess separation restricts growth. Chronic alcohol administration doesn't allow us to experience the very first stage of social-isolation induced pain. never underestimate the relief and the opportunity for development that vociferous complaints and protesting afford us :) What is bad or deadly for an infant, changes its character for a grown-up mainly because he can rely on inmense cognitive resourses unavailable to the infant...
> Finally, is there any evidence that the augmentation strategy itself can poop out?
sounds like concern about facing some pile of elephant dung in a near future... LOL :)))
M.
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