LDN’s capacity to modulate the immune system has wide potential applicability.
By Judy Tsafrir, M.D.
Reprinted by permission from Psychology Today.
I have been aware of the existence of Low Dose Naltrexone for some time, but never considered prescribing it to my patients or taking it myself, until I attended a conference entitled “Solving the Puzzle of Autoimmunity: the Interplay of Gut, Genes and the Environment.” Though the conference was not officially about psychiatric disorders, I am convinced that most of what was discussed is directly relevant and applicable to the origin and healing of most psychiatric problems.
The conference was inspiring and I came back enthusiastic to try a variety of new approaches, both on myself and my patients. Fecal Transplants and Helminth Therapy were high on my list, but fecal matter and worms are still difficult to obtain and complicated to administer. In contrast, another modality, Low Dose Naltrexone (LDN), a conventional pharmaceutical, is readily available, safe, inexpensive and according to the lecturers, has wide applicability and efficacy.
Two physicians, Leonard Winestock, MD and Jill Cottel MD, who have extensive experience using it with large numbers of patients, reported that they often had excellent results in terms of achieving improvement and even remission in a wide variety of conditions. There are studies reporting its efficacy not only in classic autoimmune illnesses such ulcerative colitis, rheumatoid arthritis, multiple sclerosis and psoriasis, but also in diverse conditions such as cancer, fibromyalgia, chronic fatigue, histamine intolerance and mast cell activation disorder, autism, chronic pain and complex regional pain syndrome, AIDS, PTSD and depression.
Naltrexone, an opiate antagonist, was developed in 1963. Originally Naltrexone 50 mg was prescribed to treat opioid addiction and alcoholism. Due to receptor blockade, patients taking Naltrexone would not get high from opioids or alcohol. Unfortunately it was very poorly tolerated by patients. It resulted in dysphoria, as it not only blocked the effects of the intoxicants, but also blocked the naturally occurring endorphins in the body. Patients did not like how it made them feel and refused to take it. Endorphins are naturally occurring substances that create a feeling of well being, such as the euphoria experienced by long distance runners. They also play an important role in modulating the immune response, and in reducing pain and inflammation.
Low Dose Naltrexone is prescribed at doses between 0.5-4.5 mg, which at that low dose briefly blocks the opioid receptors for a few hours. Subsequently a rebound effect occurs, with increased production of endorphins, resulting in an enhanced feeling of well being, as well as a reduction in pain and inflammation. There are very few side effects. The most common one is vivid dreams, which typically resolves after a few days, but recurs when the dose is increased. Other side effects that have been reported include headaches, GI symptoms and insomnia. But side effects are typically mild and transient, if in fact, any are experienced at all.
Low Dose Naltrexone is contraindicated in patients who are taking pain medications and immune suppressive therapies. It must be obtained from a compounding pharmacy and generally costs less than one dollar a day. It is preferable to take the smallest possible effective dose.
I am interested in its capacity to reduce gut permeability and the permeability of the blood brain barrier. Most patients who come to see me have psychiatric symptoms that are caused by a leaky gut, a leaky brain and inflammation. The risk of a trial of Low Dose Naltrexone is low and the potential benefit high. Upon my return from the conference I began to prescribe it to a number of patients and began to take it myself. I recommend starting with 0.5 mg and increasing at two week intervals if there was no response, up to a maximum dose of 4.5 mg.
My very limited initial results have been promising. I personally experienced mood elevation and an increase in my motivation and productivity. One patient with lupus had terrible pain in her hands which would awaken her at night. She would need to massage her arms and hands and often could not fall back to sleep, and then felt irritable the next day. After taking LDN for a week, she began to sleep through the night without awakening in pain. Her irritability disappeared. Another patient had terrible premenstrual syndrome with severe dysphoria and irritability. She has not experienced these mood symptoms during her last two cycles since she has been taking it. Another patient had a compulsive eating problem and was addicted to sugar. She has been able to maintain a healthy diet since starting LDN, and has not been at the mercy of her cravings. She reports feeling that her low grade depression has lifted and she is no longer procrastinating on a number of tasks. Its only been two months, so I am just beginning to gain experience with it. The most common side effect has been restless sleep initially, but that seems to resolve quickly.
Interestingly, Neil Nathan, MD, an expert who I often consult when I have patients in my practice with mold toxicity, wrote in a private communication that he never has seen Low Dose Naltrexone work in any autoimmune condition. He wrote that it sometimes helps with energy and cognition. Amy Myers, MD the well known integrative physician, also wrote in a post that she has not witnessed dramatic results with her patients. It’s hard to know how to understand these discrepancies. The presenters at the conference reported impressive results in many cases, though not all.
Not surprisingly, the efficacy of Low Dose Naltrexone is increased by eating an autoimmune paleo type diet. It is particularly important to avoid gluten and casein, as they interact with the opioid receptors. The diet should also include a wide variety of vegetables.
It is a testament to the potentially high benefit and low risk that a conventional pharmaceutical was featured at a Functional Medicine conference, and that for many years an organization like the Weston A Price Foundation has also been a strong proponent of its potential benefits.
My thinking is as follows: our current environment is so toxic and stressful, that we need to make use of all possible measures to strengthen our immunity, in order to maintain our health. I am excited about this exploration of the potential benefits of Low Dose Naltrexone, and eager to gain more experience with it.
If you would like to find a doctor who prescribes Low Dose Naltrexone in your area, you can go to the LDN Science website to find a clinician.
Denise K. Patton, Bob G Schultz, Daniel J Berlau. 2018 The Safety and Efficacy of Low‐Dose Naltrexone in the Management of Chronic Pain and Inflammation in Multiple Sclerosis, Fibromyalgia, Crohn’s Disease, and Other Chronic Pain Disorders Pharmacotherapy
Metyas, S, Chen CL, Yeter, K, Soyman, J, Arkfeld, DG 2018 Low Dose Naltrexone in the Treatment of Fibromyalgia, Current Rheumatology Reviews 14(2):177-180
David Mischoulon, Lindsay Hylek, Albert S. Yeung, Alisabet J. Clain, Lee Baer, Cristina Cusin, Dawn Flosnik Ionescu, Jonathan E. Alpert, David P. Soskin, Maurizio Fava Randomized, proof-of-concept trial of low dose naltrexone for patients with breakthrough symptoms of major depressive disorder on antidepressants. J Affect Disord. 2017 Jan 15;208:6-14.
Copyright © Judy Tsafrir, M.D.
Reprinted by permission from Psychology Today. Further reproduction or distribution is prohibited without permission from Judy Tsafrir, M.D.