Posted by Anna Laura on May 2, 2001, at 2:22:03
In reply to Help. Does naltrexone (Revia) work for depression?, posted by SLS on May 1, 2001, at 19:34:37
> Has anyone had success with naltrexone?
>
> What drugs are good to combine it with?
>
> Thanks in advance...
>
>
> - ScottHi Scott,
I found this article on the tips section: it's a success story with naltrexone. May be you'll find it interesting.....
Date: Fri, 06 Jun 1997 18:23:23 -0700
From: Lee Dante < ldante@pol.net >
Subject: Augmentation of clomipramine with naltrexoneI began using naltrexone clinically a number of years ago. I had long felt that the opiate system was a major player in depression but needed a way of intervening that didn't run the risk of inducing addiction. (Virtually all partial agonists have caused addiction problems and only naltrexone, the pure antagonist, has shown no addictive potential or significant morbidity after almost two decades of clinical use.) After twenty five years of seeing psychiatric patients I have had many patients referred to me who suffer from intractable depressions.
One woman in her twenties had been under my care for three years. She had been hospitalized three times before I got her. She had an eating disorder, had tried suicide, and had in the past done "delicate slicing". She had unremitting depression only weakly responsive to MAOIs, every TCA at therapeutic doses, ECT, fluoxetine, sertraline, and clomipramine. Trazodone, augmentation with lithium, and thyroid were not helpful. She had no relief from trials of anticonvulsant medications. As often happens with the chronically ill she disappeared for a year. When she returned she began by saying,"Doc, could you give me the Anafranil (clomipramine) again (200 mg)? Nothing will ever cure my depression but at least I could sleep." I agreed but asked her if she would try another augmentation strategy. I explained that the approach was not even remotely standard practice, etc. She answered with a shrug.
Four weeks after I added 25 mg of naltrexone at bedtime she phoned me. "Doc, I was playing badminton with my family and I suddenly realized that I was having fun! I have never felt that before!" If I stopped either medicine she would start to relapse. Two years later she was still depression free and engaged. (This woman had been terrified of men having watched her father beat her brother and mother to a pulp in regular alcoholic rages since she was just out of diapers.) I just got a card from this particular patient telling me that she was pregnant and happily married.
I have learned through bitter experience to believe only results. This was no placebo response. Neither one of us really expected her to do so well having been down the augmentation trail together many times. I knew after this experience that the question was not *if* this was worthwhile but rather *in whom*.
Although the next handful of patients were similarly desperate cases, I no longer restrict the use of this strategy to the "last chance" scenario. In fact, I've done this now with well over fifty of my patients.
poster:Anna Laura
thread:61293
URL: http://www.dr-bob.org/babble/20010424/msgs/61342.html