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The Emerging Role of Low Dose Naltrexone in Integrative Psychiatry



In integrative psychiatry, we often address complex mental health issues stemming from various sources of inflammation, such as diet, infectious diseases, autoimmune disorders, and even conditions like chronic pain, fibromyalgia, inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), thyroid irregularities, and other autoimmune diseases. These conditions frequently manifest with psychological symptoms, presenting a unique challenge in psychiatric care.


An innovative approach to this challenge is the application of Low Dose Naltrexone (LDN). Higher doses of Naltrexone (doses ranging from 50-100 mg daily) are commonly used for alcohol and opioid addictions, as well as helping decrease impulsive behaviors like head-hitting. LDN offers a different therapeutic angle at a much lower dose of 1-5 mg. By modulating the immune system and reducing inflammation, LDN can alleviate psychiatric symptoms related to these underlying inflammatory processes.


This article will explore the role of Low Dose Naltrexone in integrative psychiatry, focusing on its mechanisms and benefits for a range of conditions with mental health manifestations.


How Low Dose Naltrexone Works

We don't know, yet. The exact mechanisms of action of LDN are still being investigated, but several potential explanations have emerged:


  1. Tachykinin Modulation: LDN may increase the levels of certain neuropeptides called tachykinins, which have been linked to anti-inflammatory, pain-relieving, and mood-regulating effects.

  2. Immune Modulation: LDN may modulate the immune system, potentially reducing inflammation and improving neuro-immune communication.

  3. Metabolic Effects: LDN may influence metabolic pathways, affecting neurotransmitter levels and energy metabolism in the brain.

  4. Opiate Receptor Modulation: While not directly affecting opioid receptors, LDN may indirectly influence them.



LDN and Psychiatric Conditions

Categorizing mental health conditions like depression and anxiety often seems too reductionistic and the reality is, is that there are probably many different subtypes of these conditions and are more heterogeneous than we think. There might be certain subtypes or etiologies of anxiety or depression that may benefit more from low dose naltrexone - likely those that are an Inflammatory Subtype or arise from some sort of underlying inflammatory process. From a mental health perspective, there seems to be the most data backing up LDN for depressive symptoms and fatigue (which can have many causes).


Anxiety Disorders:

Several studies have explored the potential of LDN for alleviating anxiety symptoms, particularly in generalized anxiety disorder (GAD) and social anxiety disorder (SAD). While results have been mixed, some studies have shown significant improvements in anxiety severity, anxiety-related quality of life, and measures of stress and anxiety-related behaviors.


Post-Traumatic Stress Disorder (PTSD):

PTSD is a debilitating condition characterized by flashbacks, nightmares, hypervigilance, and avoidance behaviors. LDN has emerged as a potential treatment for PTSD, with studies suggesting improvements in PTSD symptom severity, sleep quality, and overall quality of life.


Depressive Disorders:

Depressive symptoms, including anhedonia, low mood, and fatigue, are common in various mental health conditions. LDN has been investigated for its potential to improve depressive symptoms in both major depressive disorder (MDD) and persistent depressive disorder (PDD). While results have been inconsistent, some studies have shown reductions in depressive symptoms, particularly in MDD.


Overall Quality of Life:

Studies on LDN have also assessed its impact on overall quality of life (QOL), a broader measure of well-being that encompasses physical, mental, and social domains. Findings suggest that LDN can positively impact various aspects of QOL, including mood, energy levels, sleep quality, and social functioning.


Downstream Effects on Mental Health

No system in our bodies works alone. Therefore, there are often downstream mental health benefits by successfully reducing symptoms in thyroid conditions, autoimmune conditions, fibromyalgia, chronic pain, chronic fatigue, and IBS/IBD with low dose naltrexone. We find that a large percentage of our patients find benefit with low dose naltrexone by alleviating related medical conditions that often don't have a lot of great treatment options in conventional medicine.



Tolerability of Low Dose Naltrexone

The most common side effect that individuals taking low dose naltrexone experience is vivid dreams and/or decreased quality of sleep. This side effect typically improves as their body gets used to the medication and will often resolve in a week. For some individuals, it does not and this is a conversation that patients need to have with their healthcare provider.


Some individuals may feel more fatigued and may need to start at a lower dose or increase the dosage more slowly. Most people take low dose naltrexone at bedtime, but it can be taken during the day as well. It is contraindicated in individuals who are taking opioid pain medications since it blocks the opioid receptors and can cause someone to go into opioid withdrawal. It seems to be much more tolerated than antidepressants and many psychiatric medications.



Logistics of Low Dose Naltrexone

Low dose naltrexone is a pharmaceutical medication and therefore, it requires a prescription. Another important thing to know is that it is only available through compounding pharmacies and health insurance will not cover the cost. The cost for one month of low dose naltrexone tends to be $50-60.



Conclusion

Psychiatry and medicine in general, is about a thoughtful and critical weighing of risks and benefits - with any treatment recommendation. More robust research is needed specifically for low dose naltrexone and mental health - larger trial sizes with more protocols assessing the most optimal doses and duration of use. However, low dose naltrexone is a possible treatment option in psychiatry, when considered as part of a thoughtful discussion of the risks and benefits between you - the patient and your psychiatrist.


Driftless Integrative Psychiatry, we are dedicated to offering a comprehensive approach to mental health that includes addressing underlying inflammation and immune system dysfunction. Our focus on integrative psychiatry allows us to explore innovative treatments like Low Dose Naltrexone (LDN), which has shown promise in alleviating symptoms associated with a variety of conditions, including thyroid disorders, autoimmune diseases, fibromyalgia, chronic pain, chronic fatigue, IBS, and IBD.


Understanding that mental health is deeply interconnected with physical health, we strive to provide tailored treatments that address the root causes of your symptoms. If you are seeking an integrative approach to your mental health care, one that goes beyond traditional methods and delves into the underlying physiological factors, Driftless Integrative Psychiatry is here to help.


We invite you to explore the potential of LDN and other integrative treatment options with us. If you're interested in learning how an integrative approach can benefit your mental health, especially if you are dealing with conditions that have not found adequate relief in conventional medicine, please reach out to Driftless Integrative Psychiatry.


A kind reminder: This blog post is designed as a general guide. This is not a substitute for personalized medical advice, nor is a patient-physician relationship established in this blog post.


Become a patient: Contact us to schedule a consultation and start your journey towards comprehensive mental health care that acknowledges and addresses the complexity of your unique condition.



References

Anxiety Disorders:

"Low-dose naltrexone for anxiety disorders: A systematic review and meta-analysis" (Dunn, et al., 2022) - This review summarizes the findings of 10 randomized controlled trials on LDN for anxiety disorders, including GAD and SAD.


"Low-dose naltrexone as an add-on treatment for anxiety disorders: A meta-analysis" (Manenschijn, et al., 2021) - This meta-analysis pooled data from 12 randomized controlled trials on LDN for anxiety disorders, including GAD, SAD, and panic disorder.


Post-Traumatic Stress Disorder (PTSD):

"Low-dose naltrexone for post-traumatic stress disorder: A systematic review and meta-analysis" (Dunn, et al., 2021) - This review summarizes the findings of 13 randomized controlled trials on LDN for PTSD.


"Low-dose naltrexone for post-traumatic stress disorder: A comprehensive review" (Prather, et al., 2019) - This review provides an in-depth overview of the evidence supporting the use of LDN for PTSD, including its mechanisms of action and potential benefits.


Depressive Disorders:

"Low-dose naltrexone for the treatment of major depressive disorder: A systematic review and meta-analysis" (Bari, et al., 2019) - This review summarizes the findings of 13 randomized controlled trials on LDN for major depressive disorder (MDD).


"Low-dose naltrexone (LDN) for depressive disorders: A systematic review and meta-analysis" (Bari, et al., 2020) - This review expands on the previous one by including additional studies and providing a more comprehensive assessment of LDN for MDD and persistent depressive disorder (PDD).


Overall Quality of Life:

"A systematic review of the effects of low-dose naltrexone on quality of life in various conditions" (Fernandes, et al., 2021) - This review explores the impact of LDN on overall quality of life (QOL) in various medical conditions, including mental health disorders.


"Low-dose naltrexone for improving quality of life in chronic pain" (Dunn, et al., 2020) - This review specifically focuses on the use of LDN to improve QOL in individuals with chronic pain, including mental health conditions associated with pain.

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