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Discussion Starter · #1 ·
Hi everybody,

you probably all know that there is some evidence that the non-selective opioid receptor antagonist Naltrexone was found to be helpful for some people with DP/DR.
However, there also seems to be some evidence that it's especially (agonism at) the kappa-opioid receptor which induces DP/DR: Enadoline, a selective kappa opioid agonist: comparison with butorphanol and hydromorphone in humans - PubMed

As far as I know, selective kappa opiod receptor antagonists (which might be the cure for DP/DR) are mostly only available for research purposes. A few examples: JDTic, Zyklophin, nor-BNI, Aticaprant, ...
For an overview, see: https://en.wikipedia.org/wiki/Κ-opioid_receptor#Antagonists

However, it seems to me that the only available kappa antagonists are Naltrexone/Naloxone and Buprenorphine.

Am I missing out on something? Are there more kappa-antagonists available yet which I didn't recognize?

And has anybody had experiences with buprenorphine? (I know one shouldn't use it long-term of course.)

Thanks and greets! :)
 

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Basically there are currently 5 choices:

  • Naltrexone at high doses, which may cause liver toxicity, has unpleasant side-effects and is very expensive. Unless you are rich, you cannot sustain a steady supply of Naltrexone.
  • Nalmefene at high doses, which does not cause liver toxicity, but it's other side-effects are similar to naltrexone and it is even more expensive.
  • Combining buprenorphine with naltrexone, which blocks the action of buprenorphine on μ-opioid-receptors and therefore it's addictive effects. Probably the most cost-efficient choice, but hard to get prescribed.
  • Using buprenorphine alone might work as well, but getting off it is probably very hard.
  • Another alternative could be naloxone infusions. There actually is a doctor in Germany offering them for depersonalization disorder, but you will have to pay for them by yourself:
    rTMS + Ketamin und tDCS + Ketamin | Depressionsbehandlung mit rTMS-Neuromodulation Praxis Dr. Tamme (wege-aus-der-depression.de)
 

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Discussion Starter · #3 ·
Basically there are currently 5 choices:

  • Naltrexone at high doses, which may cause liver toxicity, has unpleasant side-effects and is very expensive. Unless you are rich, you cannot sustain a steady supply of Naltrexone.
  • Nalmefene at high doses, which does not cause liver toxicity, but it's other side-effects are similar to naltrexone and it is even more expensive.
  • Combining buprenorphine with naltrexone, which blocks the action of buprenorphine on μ-opioid-receptors and therefore it's addictive effects. Probably the most cost-efficient choice, but hard to get prescribed.
  • Using buprenorphine alone might work as well, but getting off it is probably very hard.
  • Another alternative could be naloxone infusions. There actually is a doctor in Germany offering them for depersonalization disorder, but you will have to pay for them by yourself:
    rTMS + Ketamin und tDCS + Ketamin | Depressionsbehandlung mit rTMS-Neuromodulation Praxis Dr. Tamme (wege-aus-der-depression.de)
Why wouldn't my insurance pay for a Naltrexone treatment?

Isn't Nalmefene an agonist on kappa receptors?
 

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Why wouldn't my insurance pay for a Naltrexone treatment?
Because it's not approved for treating depersonalization disorder. Insurance is not obliged to pay for off-label treatments, unless it's a widely accepted treatment by the medical community. You will need a private prescription.

Isn't Nalmefene an agonist on kappa receptors?
It's a partial agonist.
 

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My family doctor easily prescribed me naltrexone, but I asked for it to help wean off alcohol. I’m not saying you should lie to your doctor and I’m not here to give any medical advice, but if you have insurance it should be pretty easy to obtain.
 

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One of the psychiatrists gave it to me, because I had told him I saw a scientific article where they tried it for DPDR. He said he didn't mind prescribing it even though I don't have any problem with alcohol, because he is very used to this medicine and said it wouldn't hurt to try. But the other psychiatrists I have seen would probably never have let me try it, because they would be responsible for not respecting medicines regulations if anything happened.
And also it didn't help me much at 6 mg and at 25 mg.
 
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