Low dose Naltrexone therapy for psychiatric conditions

Low-dose Naltrexone therapy is an exciting, relatively new concept being used for a variety of treatment resistant psychopathology. There is data that it is effective for a range of psychiatric diseases including major depression, Bipolar disorder, panic/anxiety, OCD, opiate/alcohol post-withdrawal symptoms and cravings and eating disorders. Usually treatments with such a broad range of effectiveness are suspect, however the unique nature of this treatment makes this treatment able to cast such a wide net in an efficacious fashion.

Naltrexone is an opiate receptor antagonist which blocks both ingested opiates (heroin or pain pills) and endogenous opiates better known as “Endorphins” from binding to our own receptors and having an effect. Naltrexone has been traditionally used in full dose strength at 50mg per day to treat cravings in alcohol addiction and opiate addiction.  It has however been extremely disappointing in terms of its benefit when used in these modalities. It enjoys great success also as a reversal for heroin and pain pill over-dose in which it is a life saving measure however not applicable for the majority of people.

Low-dose Naltrexone on the scale of 0.5-2.5mg per night induces our own neuro-circuitry to produce increasing amounts of endorphins and not rely directly on the drug for effect. Your brain produces its maximum number of endorphins from 10Pm-2AM each night and the mechanism of action for Naltrexone is as follows: By blocking your opiate receptors (in which endorphins bind to and produce a positive effect on mood, relief of anxiety and even healing inflammation and other disease processes) in very small amounts, it essentially masks a percentage of receptors from your brain’s ability to see them.  When your brain sees that there are less receptors than there should be, your brain starts to produce an increase in Endorphins to make-up for the lack of receptors by making sure the available receptors are fully activated by maximum amount of endorphins.  Given the dose of Naltrexone used is so low, the blocking effect is very transient and within hours the receptors are again exposed and now the plethora of extra endorphins floating around can bind to and activate the many receptors.

Essentially “tricking” your brain into thinking you have a deficit in endorphin related circuits and thus you will activate these pathways. I have had great success in treating many disorders resistant to traditional medication treatment and there is a lot of hope for using low dose naltrexone in disorders in which traditional pharmacotherapy is not effective. Especially alcohol and opiate addiction, eating disorders and bipolar depression.  Given its healing benefits there is also wide-spread thought that it can drastically help with MS, fibromyalgia, chronic fatigue and potentially even cancers and other inflammatory conditions.  There is not hard data however and it is all speculation at this point.

Given the side-effect profile is almost non-existent due to the extremely small dose, the potential risk-benefit ratio is well worth it for the majority of people, especially if you have failed traditional treatment.

Michael Yasinski MD