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NALTREXONE or NALOXONE for derealization? Expiriences.


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#1

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Posted 22 March 2009 - 04:30 PM

Hallo! I'm a doctor and I live with my DD for at least 10 years. I tried many medications, but they just help me to cope with my comorbid depressive simptoms, leaving derealization intact...

I'm going to try naltrexon, because It makes sense from patophisiological point of view!

In Pub Med I've found the only few articles

Expert Rev Neurother. 2008 Jan;8(1):19-26.
Depersonalization disorder: pharmacological approaches.

Sierra M.
Depersonalization Research Unit, Institute of Psychiatry, King's College, Section of Neuropsychiatry P068, De Crespigny Park, Denmark Hill, London SE5 8AF, UK. [email protected]

Depersonalization disorder (DPD) is a chronic and distressing condition with a prevalence in the general population between 0.8 and 2%. Several neurobiological studies in the last decade have shown that patients have suppressed limbic activation to emotional stimuli. Such findings are in line with a model which suggests that the condition is generated by an anxiety-triggered, 'hard-wired' inhibitory response to threat. Such a mechanism would ensure the preservation of adaptive behavior, during situations normally associated with overwhelming and potentially disorganizing anxiety. In DPD, such a response would become chronic and dysfunctional. Depersonalization remains a condition for which no definitive treatment exists, and for which conventional medications, such as antidepressants or antipsychotics, have been found to be of little value. Fortunately, a few promising lines of pharmacological treatment have emerged in recent years, although more rigorous studies are needed. For example, a number of studies suggest that opioid receptor antagonists such as naltrexone and naloxone are useful in at least a subgroup of patients. In spite of initial expectations, the use of lamotrigine as a sole medication has not been found useful. However, open-label trials suggest that its use as an add-on treatment with selective serotonin reuptake inhibitors (SSRIs) is beneficial in a substantial number of patients. Similarly, the use of clonazepam, particularly in conjunction with SSRI antidepressants, appears to be beneficial in patients with high levels of background anxiety. In line with the stress-related model of depersonalization, those neurotransmitter systems of relevance to depersonalization are known to play important inhibitory roles in the regulation of the stress response.
PMID: 18088198 [PubMed - indexed for MEDLINE]
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J Clin Psychopharmacol. 2005 Jun;25(3):267-70
An open trial of naltrexone in the treatment of depersonalization disorder.
Simeon D, Knutelska M.
Department of Psychiatry, Mount Sinai School of Medicine, New York, NY 10029, USA. [email protected]

Depersonalization disorder (DPD) remains one of the few disorders in modern psychiatry for which no treatments are established that are even partially effective, whether pharmacological or psychotherapeutic. Depersonalization disorder is a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition dissociative disorder characterized by a pervasive subjective sense of unreality and detachment with intact reality testing. Two recent controlled medication trials, one with lamotrigine and one with fluoxetine, failed to show efficacy. There is some evidence for dysregulation of endogenous opioid systems in depersonalization, and a few studies have suggested that opioid antagonists may have efficacy in the treatment of dissociation and depersonalization symptoms. In this prospective open treatment trial, 14 subjects were recruited and treated with naltrexone for 6 weeks to a maximum dose of 100 mg/d (first 7 subjects) or 10 weeks to a maximum dose of 250 mg/d (next 7 subjects). Mean naltrexone dose was 120 mg/d. There was an average 30% reduction of symptoms with treatment, as measured by 3 validated dissociation scales. Three patients were very much improved, and 1 patient was much improved with naltrexone treatment. These findings are potentially promising in a highly treatment-refractory disorder for which no treatment guidelines exist and warrant a randomized controlled trial.
PMID: 15876908 [PubMed - indexed for MEDLINE]
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J Psychopharmacol. 2001 Jun;15(2):93-5. -
Effect of naloxone therapy on depersonalization: a pilot
study.Nuller YL, Morozova MG, Kushnir ON, Hamper N.
Bekhterev Psychoneurological Research Institute, St-Petersburg, Russia. [email protected]

To test the hypothesis of the role for the opioid system in the pathogenesis of depersonalization, the effect of naloxone (an opioid receptor blocker) on the symptoms and corticosteroids secretion was studied in patients with depersonalization syndrome. Fourteen depersonalization patients were treated with naloxone: 11 patients received single doses (1.6 or 4 mg i.v.) and three others received multiple infusions, with the maximal dosage being 10 mg, and the effect of naloxone on symptom severity was determined. In eight patients, the cortisol, cortisone and corticosterone content in the blood plasma was determined prior to and after the 4 mg naloxone infusion. A reversed-phase microcolumn high-performance liquid chromatography with ultraviolet detection was applied for assessment of glucocorticoids. In three of 14 patients, depersonalization symptoms disappeared entirely and seven patients showed a marked improvement. The therapeutic effect of naloxone provides evidence for the role of the endogenous opioid system in the pathogenesis of depersonalization.
PMID: 11448093 [PubMed - indexed for MEDLINE]
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J Clin Psychiatry. 1999 Sep;60(9):598-603.
Naltrexone in the treatment of dissociative symptoms in patients with borderline personality disorder: an open-label trial

Bohus MJ, Landwehrmeyer GB, Stiglmayr CE, Limberger MF, Böhme R, Schmahl CG.
Department of Psychiatry, University of Freiburg, Freiburg im Breisgau, Germany. [email protected]

BACKGROUND: Dissociative phenomena, including flashbacks, are common in patients with borderline personality disorder and posttraumatic stress disorder (PTSD). Although dissociative symptoms can be severe and may interfere with psychotherapy, there is no established pharmacotherapy for these symptoms. Evidence suggests that alterations of the endogenous opiate system contribute to dissociative symptoms in patients with borderline personality disorder and PTSD. METHOD: We treated 2 groups of female borderline personality disorder patients (N = 13, with an overlap of 5 patients between the 2 groups; all met the diagnostic criteria of DSM-IV and the revised Diagnostic Interview for Borderline Patients) who experienced prominent dissociative phenomena including flashbacks with the nonselective opiate receptor antagonist naltrexone, 25 to 100 mg q.i.d., for at least 2 weeks. A self-rated questionnaire measuring dissociation, analgesia, tonic immobility, and tension (DAISS) was applied to 9 patients, who completed it for 7 consecutive days before and during treatment with naltrexone. In addition, 9 patients (with an overlap of 5 patients from the other group) completed a flashback protocol. RESULTS: DAISS scores reflected a highly significant reduction of the duration and the intensity of dissociative phenomena and tonic immobility as well as a marked reduction in analgesia during treatment with naltrexone. Six of 9 patients reported a decrease in the mean number of flashbacks per day. CONCLUSION: These observations support the hypothesis that an increased activity of the opioid system contributes to dissociative symptoms, including flashbacks, in borderline personality disorder and suggest that these symptoms may respond to treatment with opiate antagonists. In view of these results, a placebo-controlled, double-blind study to assess the potential benefit of naltrexone in a more rigorous way appears justified.
PMID: 10520978 [PubMed - indexed for MEDLINE]


#2

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Posted 22 March 2009 - 04:37 PM

Please if anyone tried Naltrexone or any other opiod antagonist in treatment of depersonalisation, share your expirience here.

As soon as I have myself tried this medication, I report the results here

#3 nabber

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Posted 22 March 2009 - 05:08 PM

Hey Dr. Phaeton,

I was just prescribed naltrexone 3.5mg , I'm going to start it next week. I'll keep you , and everyone updated on how it works.
It's a really low dosage so i'm skeptical , but might as well give it a try eh? Pick up a copy of 'Feeling Unreal.' It's written by
one of the leading psychiatric experts concerning Depersonalization in the U.S. There's a paragraph
of two case studies where they had 14 patients given 120mg per day of Naltrexone over a two week period and it worked well
for 3 of them.

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Posted 22 March 2009 - 05:16 PM

Thanks a lot for your intention to keep us updated! :D

I will try to start with 25mg/d of Naltrexone, or maybe Naloxone injection of 0,4 mg...


I suppose Naltrexone or Naloxone monotherapy is not usefull.

I can quote Nuller that Naloxon exacerbated anxiety and depression. So it seems reasonable to take opioid antagonists only in combination with anxiolytics and antidepressants.


I also have a very positive personal experience of using mirtazapine (30mg/d) + milnacipran (100-150mg/d) as a very potent long-term antidepressive combination, that prevents seasonal rise in severity of my derealization/depersonalization symptoms. This combination is unic and is much better tallerated than each medication in monotherepy.

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Posted 22 March 2009 - 05:27 PM

I was just prescribed naltrexone 3.5mg..... It's a really low dosage so i'm skeptical , but might as well give it a try eh?...


I suppose your doctor will observe your progress and titrate the dose untill it works...

#6 nabber

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Posted 22 March 2009 - 05:42 PM

I was just prescribed naltrexone 3.5mg..... It's a really low dosage so i'm skeptical , but might as well give it a try eh?...


I suppose your doctor will observe your progress and titrate the dose untill it works...



Yeah , that's the plan. I will go back in a month and see her, and see if it has had any effects at all. I take Xanax XR, Lamictal, and Lexapro right now. Seems to
be a good combo, but I'm sort of in a rut right now with the economy being so bad I think I spend to much time focusing on negative things. Yeah the Nalaxone
only lasts 30-40 minutes I think, i'm no expert at all when it comes to meds. But I hear it works really well, I'd go in for just one shot of it, just a glimpse of reality
would be overwhelming.I wish you well, keep me updated on the 25mg and we can trade notes , and see if the higher dose has a better effect.

#7 Johnny Dep

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Posted 23 March 2009 - 03:27 AM

Hey Dr. Phaeton,

I was just prescribed naltrexone 3.5mg , I'm going to start it next week. I'll keep you , and everyone updated on how it works.
It's a really low dosage so i'm skeptical , but might as well give it a try eh? Pick up a copy of 'Feeling Unreal.' It's written by
one of the leading psychiatric experts concerning Depersonalization in the U.S. There's a paragraph
of two case studies where they had 14 patients given 120mg per day of Naltrexone over a two week period and it worked well
for 3 of them.



I think 50mg a day is how much you need to block opiates for the entire day, thats how much they give opiate addicts. This is from memory, maybe I'm wrong on that. Even at the doses they give opiate addicts this is a very safe drug, I don't know they are so reluctant to give full doses. Its safer than aspirin. Anyway, I'm personally intrigued by the use of Naltrexone for DP, I tried Kratom, which is legal where I live, and it did remind me of the way I feel when I separate from painful reality during difficult experiences. The endorphin addiction hypothesis does make sense to me, at least worth further investigation. Unfortunately I don't think Low Dose Naltrexone is really the answer, its only enough to block endorphins/opiates for a few hours. I also think some of the doctors promoting LDN for things like cancer, people like Dr. Bihari, are quacks and financially benefiting from a fraud. If you have cancer and do a "phone consultation" with Bihari for a $500 "donation" to his research he will mail you a prescription for LDN. These phone consults last a few minutes and at these doses the chances of someone getting hurt from the drug is microscopically low. Scam.

#8 nabber

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Posted 23 March 2009 - 04:11 PM

I think 50mg a day is how much you need to block opiates for the entire day, thats how much they give opiate addicts. This is from memory, maybe I'm wrong on that. Even at the doses they give opiate addicts this is a very safe drug, I don't know they are so reluctant to give full doses. Its safer than aspirin. Anyway, I'm personally intrigued by the use of Naltrexone for DP, I tried Kratom, which is legal where I live, and it did remind me of the way I feel when I separate from painful reality during difficult experiences. The endorphin addiction hypothesis does make sense to me, at least worth further investigation. Unfortunately I don't think Low Dose Naltrexone is really the answer, its only enough to block endorphins/opiates for a few hours. I also think some of the doctors promoting LDN for things like cancer, people like Dr. Bihari, are quacks and financially benefiting from a fraud. If you have cancer and do a "phone consultation" with Bihari for a $500 "donation" to his research he will mail you a prescription for LDN. These phone consults last a few minutes and at these doses the chances of someone getting hurt from the drug is microscopically low. Scam.



Thanks for the reply, I guess I'll give the 3mgx2 daily a month trial then see about titration. The biggest drawback I see to Naltrexone is local pharmacies dont have it, you have to special order it from an outside pharmacy, and I'm not sure if my insurance will cover it. 3mgx60 is 25 dollars. I hope the 50mgx30 isn't insanely overpriced.

I've never heard of Kratom, sounds interesting..

"Kratom also has a yohimbe-like stimulant activity, and uncaria-like immunostimulant activity. Kratom is said to produce a sense of well-being, with users reporting anti-depressant, anti-anxiety, analgesic, and even euphorigenic effects. It is paradoxically a stimulant and depressant, used to aid work and also able to contribute to rest and sleep."

#9 Johnny Dep

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Posted 23 March 2009 - 09:50 PM

Kratom is chemically distinct from opiates, but connects to opiate receptors in the same way. Its really just weak heroin. The only reason it hasn't been outlawed yet is because its new, only known outside Thailand for a few years. I don't recommend it, it reinforces negative tendencies within withdrawn, depersonalized people.

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Posted 24 March 2009 - 08:54 AM

Naloxone – trip to reality…


Today was the 1st session of trying to cope with my transient derealization.
I started with 0,4mg of Naloxone i/m injection. In 20 min I felt a little bit sad, and paid attention on that the colors became more vivid and objects edges became more distinct. But I was not shure that was not a placebo reaction, so I decided to inject 1,6mg. In about 30 min I felt very relaxed, peaceful and lazy. I did not want to contact to anyone, so I decided to lay into bed for a while. I took one banana and went to my room. It was unusually tasty and fragrant. I was feeling rather comfortable. My attempts of introspection met inner feeling of like I was bored to death with that permanent selfanalisis. It was rather discomfortable for me to think of myself. I can compare this feeling with ideational (thinking) laziness. Sometimes it seemed to me that I don’t want to think at all. Than I detected a lot of unusually intensive spark-like wishes, that disappeared quickly after origination. But the most amazing for me was one distinct and intensive feeling. It was like that I realized my genuine potential to experience happiness. This feeling was originating from inside the depth of my soul. Topically this feeling localized somewhere in the “inner core” of my chest. The depth of my chest seemed inconceivable. I have never guessed that such place exists. It was so pleasant and in the same time so natural! When I entered another room I found my perception to be objectively changed. The term that came to my mind to describe that was “naturalness”. I did not find happening to be strange. Everything was familiar. But I'd expected something another. Now I realize that I’d experienced really a great thing. The experience was so much unusual or so much forgotten for me…

It a little bit reminded me of 45mg/d Mirtazapine or benzodiazepines. But these course me to experience demoralizing indifference. In the case of Naloxone there was relaxation and peace in my sole, and naturalness of my psychic condition.

Else I found funny to meet my personality! And I liked my character and my voice (it was so unusual to have a voice!). I found a person – a new person in my body!
(Before, when I was alone in the room, I understood “there is no one here, including myself”)
You know, I found that person to be grown up already, it was a feeling like when you don’t see your friend for 10 years and one day u meet him and realize he is grown up.

But I can not say that Naloxone1,6mg completely reduced my derealization and repersonalized me…

In 4 hours after injection there was no sense of reality again… (((((



In few days I'm going to try 25mg/d Naltrexone

#11 surf

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Posted 24 March 2009 - 04:14 PM

...wow

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Posted 24 March 2009 - 04:29 PM

Next day after Naloxon.

I was more depressed than usual, feeling of self loss, indifference (hypopathy), lack of energy and motivation were more distinct, although I was on Milnacipran 100mg + Mirtazapine 15mg. May be this partially because of piracetam (3,2g/d) was withdrawn 2 days ago, or of some other reasosns (coffeine, biorhythm etc).

in the evening I took 25mg of Naltrexone orally. In about 2h after that I found myself even more derealized. I experienced a short period of ambivalent emotions, felt a slight restlessness. After that I concluded that I felt a very slight euphoria with apparent slight psychic anesthesia.

The effect did not remind me Naloxone much, but the feeling of beeing calm, a little relaxed, carefree and light-hearted that came much later was the same (in about 4 hours after ingestion).

I found Naltrexone to be interresting for further studying, so before going to bed I took 25mg of Naltrexone + 15mg of Mirtazapine + 3 mg of Melatonine.


I found some interesting information on Naltrexone single 50mg oral dose:
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In healthy adults 50 mg produces fatigue, sleepiness, lightheadedness, nausea, sweating, feeling of unreality, recurrent penile erections, and elevations of plasma luteinizing hormone. Other reactions have been suggestive of opiate agonist effects, including decreased respiratory rate, pupillary constriction, decreased oral temperature, and dysphoria. In maintenance treatment, naltrexone has induced aversive effects such as changes in mood, concentration, alertness, and motor coordination. Depression and abdominal pain have also been observed.
[Ellenhorn, M.J. and D.G. Barceloux. Medical Toxicology - Diagnosis and Treatment of Human Poisoning. New York, NY: Elsevier Science Publishing Co., Inc. 1988., p. 761]
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Because naltrexone may inhibit the effects of endogenous endorphins and decreased concentrations of endorphins in the CNS have been associated with fasting and starvation, it has been suggested that the drug may be useful as an appetite suppressant in the treatment of obesity. ... Naltrexone also may be useful in reducing the frequency of binging and purging in patients with bulimina. ... Naltrexone has been used in dosages up to 800 mg daily for the treatment of schizophrenic disorder ... . /Uses are not currently in the labeling approved by the FDA/
[McEvoy, G.K. (ed.). American Hospital Formulary Service - Drug Information 92. Bethesda, MD: American Society of Hospital Pharmacists, Inc., 1992 (Plus Supplements 1992)., p. 1183]
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