# Just started with Naltrexone



## Jamie (Mar 5, 2016)

My doctor prescribed Naltrexone to me yesterday. I´ve started on a dosage of 25mg and I am suppose to increase to 50mg after four days.

She wasn´t aware this medicin was used in the treatment of depersonalization but prescribed it anyway.

Sofar i´ve been feeling like shit. Evreything works slower, poor responsiveness, and feeling evan more detached from myself then before. I found it more difficult experience my surroundings.

I´ve read that this is helpful if you experience emotional numbness. And that is what I was hoping for with this medicine.

Is it supose to be like this in the beginning? How long does it take before you reach desired effect?


----------



## thy (Oct 7, 2015)

Ive collected some stories of people who have taken this drug here

http://www.dpselfhelp.com/forum/index.php?/topic/53570-naltrexone/

Maybe there is something there that might help you. Im afraid I dont know the answer to your questions.

Keep us updated though, I hope you start to feel better.


----------



## Allez (Apr 10, 2013)

What was it prescribed for?


----------



## thy (Oct 7, 2015)

whats the function of this system? I could probably look it up, but seeing as you are bound to know....


----------



## TDX (Jul 12, 2014)

> Unfortunately, horrible side effects are par for the course with naltrexone. What's going on is that naltrexone prefers to block mu opioid receptors (the good kind) before it blocks kappa receptors (the DP kind). In order to block kappa receptors, you need to reach >100mg doses


Often even higher dosages are mentioned, like more than 250 mg. I think this could be more accurate, given that Naltrexone is a competitive antagonist and so could be displaced by endogenous opiates if depersonalization was caused by excessive release of endogenous opiates.

Based on the Nalmefene study of Glover I suppose that the probability to tolerate a dosage of 200 mg might be 50%. Maybe the same is true for Naltrexone.

In my opinion there is a much more relevant problem than tolerance: Naltrexone (and Nalmefene) are so expensive. For example if you have to take 200 mg Nalmefene you have to pay 54 Euros per day or 1620 Euros per months.

Therefore Naltrexone as a treatment for DPD is only viable for people who respond to low dosages. Buprenorphine-Naltrexone is the only way to block the kappa-opioid receptor with tolerable side-effects and a affordable price.



> Competent psychiatrists will often prescribe it for DP after other options have failed because there's moderately good evidence for opioid antagonists.


The question is if insurance would pay for this. I suppose they would not.

But it may be useful to determine if Buprenorphine-Naltrexone could work. This could done by using Nalmefen as a "diagnostic therapy". I think if 200 mg doesn't work you can forget Buprenorphine-Naltrexone. But if it works this could be a good argument for the psychiatrist to try Buprenorphine-Naltrexone.

Maybe I would do it this way: Aquire Nalmefene and instantly throw 11 tablets (198 mg) into my throat and see if it reduces my symptoms (and I survive).


----------



## TDX (Jul 12, 2014)

> A huge nalmefene challenge seems to defeat the entire purpose of using bupe/nal to avoid the side-effects. It's cheaper and easier to just jump straight in and test with 4/40mg.


The problem is that it's not easy to make a psychiatrist prescribe Buprenorphine. But if a Nalmefene-challenge would prove that Kappa-antagonism really works this would be a strong argument for Buprenorphine.


----------



## luctor et emergo (May 22, 2015)

So when do you guys consider trying Nalmefene? If you get it prescribed that is.
If Lamotrigine does not work out and if rTMS will be next year due to the high costs I plan to give Nalmefene a second chance end of this year.
Updosing still remains a problem though... I tend to opt for fast but TDX's idea is a bit too optimistic. ;-)


----------



## TDX (Jul 12, 2014)

> In my opinion, buprenorphine + naltrexone renders nalmefene worthless. The only advantage of nalmefene* is that, in a monotherapy situation, it has a slightly more favourable kappa/mu affinity ratio (possibly offset by nalmefene actually having a kappa IA?) but it's a moot point as far as combination with buprenorphine is concerned.


Nalmefene has another advantage: We know that 200 mg may work for emotional numbness in PTSD and depression, which might be caused by it's effect on the kappa-opioid-receptor. It might be possible that this dosage is sufficient to block the kappa-opioid receptor and have an anti-depersonalisative effect. In contrast we don't really know how much Naltrexone is required. There was a study for PTSD where up to 200 mg didn't achieve the same effect as Nalmefene (it didn't do anything). Simeons study is also not of much use, because just a few people took the maximum dosage.



> It's not too hard if you don't mind the whole being completely illegal thing.


Yes, but I don't want to go illegal until I run into the glass ceiling. Another problem is that I don't really know the "scene". I never took a recreational drug. I never smoked or drank alcohol. I even never drank coffee. Regarding drug usage I'm the opposite to you.


----------

