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In this study, at endpoint, there was an average of 30% reduction of symptoms as measured by three valid dissociation scales
NALOXONE IS NOT THE SAME DRUG AS NALTREXONE - they are similar and both opioid receptor antagonists - Naloxone (or Narcan) is much stronger but doesn't stay in your system long and is usually injected. Naltrexone can last longer much longer and can be taken as a pill. i've seen a few ppl on here talk about trying naltrexone at very small doses and little success. It should be noted that this in study participates used doses between 25?250 mg/day. Please everyone post your thoughts.
Psychopharmacology Reviews: June 2005
David L. Ginsberg, MD
Primary Psychiatry. 2005;12(6):24-28
Naltrexone Treatment of Depersonalization Disorder
Depersonalization disorder (DPD) is characterized by recurrent dream-like episodes of feeling detached from one?s mental processes or body.1 Typically, the episodes are egodystonic, with patients recognizing the unreality of their symptoms. Previously considered rare, DPD is now believed to affect approximately 2% of the population, with a course that is usually chronic and continuous. While often accompanied by anxiety, a condition that may respond to anxiolytics, data on the pharmacologic treatment of depersonalization disorder is relatively limited. In fact, DPD is one of the few psychiatric disorders for which no treatment guidelines exist. Two recent controlled medication trials, one with lamotrigine2 and the other with fluoxetine,3 failed to show efficacy. There is also no demonstrated efficacious psychotherapeutic treatment. As a result, DPD remains one of the few treatment-refractory illnesses in modern psychiatry. Now comes an open-label trial4 demonstrating some utility for the opioid antagonist naltrexone in the treatment of DPD.
Fourteen subjects with DPD (12 men and 2 women) 19?51 years of age enrolled in this study. Seven of the fourteen suffered from comorbid Axis I disorders including generalized anxiety disorder (3), social phobia (3), major depressive disorder (2), dysthymia (1), panic disorder (1), obsessive-compulsive disorder (1), and somatoform disorder (1). Concomitant medications included clonazepam (4), fluoxetine (3), citalopram (2), sertraline (1), amitriptyline (1), bupropion (1), and alprazolam (1).
The first seven subjects received naltrexone for 6 weeks at a maximum daily dose of 100 mg/day. Subsequently, the trial was extended in duration and dosing so that the next seven subjects received naltrexone for 10 weeks at a maximum daily dose of 250 mg/day. The mean final naltrexone daily dose across all subjects was 120 mg/day (range: 25?250 mg/day).
At study endpoint, there was, on average, a 30% reduction of symptoms as measured by three valid dissociation scales. On the Clinical Global Impression-Improvement (CGI-I) scale, three subjects were very much improved, one subject was much improved, four subjects were slightly improved, four subjects were unchanged, and one subject was slightly worse. All three of the very much improved subjects, who experienced a ?70% reduction in symptoms, opted to continue naltrexone after completing the trial. There was no significant correlation between naltrexone dose and CGI-I score at termination.
Five subjects did not complete the entire trial duration, one of whom did not return after the baseline visit and who was therefore excluded from statistical analyses. Of the five noncompleters, two discontinued due to naltrexone-related side effects, one due to increasing depression, and the other two for unspecified reasons (lost to follow-up). Side effects reported by the 14 participants were as follows: sedation/fatigue (n=7), nausea (n=5), depression (n=3), diarrhea (n=1), insomnia (n=1), activation (n=1), tingling (n=1), feeling hot (n=1), and nightmares (n=1).
Opiate antagonists, such as naltrexone, nalmefene, and naloxone, have been reported to reduce dissociation and depersonalization in a few preliminary studies.5-7 Naltrexone is a nonspecific opioid antagonist that blocks ? receptors at low doses and other opioid receptors, such as the ? receptors, at higher doses. The ? opioid system has also been implicated in dissociation.8 Given the small number of subjects; the absence of a blinded, placebo-controlled group; and the paucity of validated medication treatments for this disabling condition, further studies using naltrexone, as well as other opioid antagonists, in the treatment of DPD are indicated. PP
References
1. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.
2. Sierra M, Phillips ML, Ivin G, Krystal J, David AS. A placebo-controlled, cross-over trial of lamotrigine in depersonalization disorder. J Psychopharmacol. 2003;17(1):103-105.
3. Simeon D, Guralnik O, Schmeidler J, Knutelska M. Fluoxetine therapy in depersonalisation disorder: randomised controlled trial. Br J Psychiatry. 2004;185:31-36.
4. Simeon D, Knutelska M. An open trial of naltrexone in the treatment of depersonalization disorder. J Clin Psychopharmacol. 2005;25(3):267-270.
5. Bohus MJ, Landwehrmeyer GB, Stiglmayr CE, Limberger MF, Bohme R, Schmahl CG. Naltrexone in the treatment of dissociative symptoms in patients with borderline personality disorder: an open-label trial. J Clin Psychiatry. 1999;60(9):598-603.
6. Glover H. A preliminary trial of nalmefene for the treatment of emotional numbing in combat veterans with post-traumatic stress disorder. Isr J Psychiatry Relat Sci. 1993;30(4):255-263.
7. Nuller YL, Morozova MG, Kushnir ON, Hamper N. Effect of naloxone therapy on depersonalization: a pilot study. J Psychopharmacol. 2001;15(2):93-95.
8. Walsh SL, Strain EC, Abreu ME, Bigelow GE. Enadoline, a selective kappa opioid agonist: comparison with butorphanol and hydromorphone in humans. Psychopharmacology (Berl). 2001;157(2):151-162.
NALOXONE IS NOT THE SAME DRUG AS NALTREXONE - they are similar and both opioid receptor antagonists - Naloxone (or Narcan) is much stronger but doesn't stay in your system long and is usually injected. Naltrexone can last longer much longer and can be taken as a pill. i've seen a few ppl on here talk about trying naltrexone at very small doses and little success. It should be noted that this in study participates used doses between 25?250 mg/day. Please everyone post your thoughts.
Psychopharmacology Reviews: June 2005
David L. Ginsberg, MD
Primary Psychiatry. 2005;12(6):24-28
Naltrexone Treatment of Depersonalization Disorder
Depersonalization disorder (DPD) is characterized by recurrent dream-like episodes of feeling detached from one?s mental processes or body.1 Typically, the episodes are egodystonic, with patients recognizing the unreality of their symptoms. Previously considered rare, DPD is now believed to affect approximately 2% of the population, with a course that is usually chronic and continuous. While often accompanied by anxiety, a condition that may respond to anxiolytics, data on the pharmacologic treatment of depersonalization disorder is relatively limited. In fact, DPD is one of the few psychiatric disorders for which no treatment guidelines exist. Two recent controlled medication trials, one with lamotrigine2 and the other with fluoxetine,3 failed to show efficacy. There is also no demonstrated efficacious psychotherapeutic treatment. As a result, DPD remains one of the few treatment-refractory illnesses in modern psychiatry. Now comes an open-label trial4 demonstrating some utility for the opioid antagonist naltrexone in the treatment of DPD.
Fourteen subjects with DPD (12 men and 2 women) 19?51 years of age enrolled in this study. Seven of the fourteen suffered from comorbid Axis I disorders including generalized anxiety disorder (3), social phobia (3), major depressive disorder (2), dysthymia (1), panic disorder (1), obsessive-compulsive disorder (1), and somatoform disorder (1). Concomitant medications included clonazepam (4), fluoxetine (3), citalopram (2), sertraline (1), amitriptyline (1), bupropion (1), and alprazolam (1).
The first seven subjects received naltrexone for 6 weeks at a maximum daily dose of 100 mg/day. Subsequently, the trial was extended in duration and dosing so that the next seven subjects received naltrexone for 10 weeks at a maximum daily dose of 250 mg/day. The mean final naltrexone daily dose across all subjects was 120 mg/day (range: 25?250 mg/day).
At study endpoint, there was, on average, a 30% reduction of symptoms as measured by three valid dissociation scales. On the Clinical Global Impression-Improvement (CGI-I) scale, three subjects were very much improved, one subject was much improved, four subjects were slightly improved, four subjects were unchanged, and one subject was slightly worse. All three of the very much improved subjects, who experienced a ?70% reduction in symptoms, opted to continue naltrexone after completing the trial. There was no significant correlation between naltrexone dose and CGI-I score at termination.
Five subjects did not complete the entire trial duration, one of whom did not return after the baseline visit and who was therefore excluded from statistical analyses. Of the five noncompleters, two discontinued due to naltrexone-related side effects, one due to increasing depression, and the other two for unspecified reasons (lost to follow-up). Side effects reported by the 14 participants were as follows: sedation/fatigue (n=7), nausea (n=5), depression (n=3), diarrhea (n=1), insomnia (n=1), activation (n=1), tingling (n=1), feeling hot (n=1), and nightmares (n=1).
Opiate antagonists, such as naltrexone, nalmefene, and naloxone, have been reported to reduce dissociation and depersonalization in a few preliminary studies.5-7 Naltrexone is a nonspecific opioid antagonist that blocks ? receptors at low doses and other opioid receptors, such as the ? receptors, at higher doses. The ? opioid system has also been implicated in dissociation.8 Given the small number of subjects; the absence of a blinded, placebo-controlled group; and the paucity of validated medication treatments for this disabling condition, further studies using naltrexone, as well as other opioid antagonists, in the treatment of DPD are indicated. PP
References
1. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.
2. Sierra M, Phillips ML, Ivin G, Krystal J, David AS. A placebo-controlled, cross-over trial of lamotrigine in depersonalization disorder. J Psychopharmacol. 2003;17(1):103-105.
3. Simeon D, Guralnik O, Schmeidler J, Knutelska M. Fluoxetine therapy in depersonalisation disorder: randomised controlled trial. Br J Psychiatry. 2004;185:31-36.
4. Simeon D, Knutelska M. An open trial of naltrexone in the treatment of depersonalization disorder. J Clin Psychopharmacol. 2005;25(3):267-270.
5. Bohus MJ, Landwehrmeyer GB, Stiglmayr CE, Limberger MF, Bohme R, Schmahl CG. Naltrexone in the treatment of dissociative symptoms in patients with borderline personality disorder: an open-label trial. J Clin Psychiatry. 1999;60(9):598-603.
6. Glover H. A preliminary trial of nalmefene for the treatment of emotional numbing in combat veterans with post-traumatic stress disorder. Isr J Psychiatry Relat Sci. 1993;30(4):255-263.
7. Nuller YL, Morozova MG, Kushnir ON, Hamper N. Effect of naloxone therapy on depersonalization: a pilot study. J Psychopharmacol. 2001;15(2):93-95.
8. Walsh SL, Strain EC, Abreu ME, Bigelow GE. Enadoline, a selective kappa opioid agonist: comparison with butorphanol and hydromorphone in humans. Psychopharmacology (Berl). 2001;157(2):151-162.
