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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by Wayne R. on September 19, 1999, at 10:56:16
I continue to experience miraculous relief of my depression since having augmented an SSRI antidepressant with Naltrexone (ReVia). However, I also have noticed that many have not shared in my success. I would like to offer some tips to anyone who is interested in trying Naltrexone augmentation. Remember, I am not a doctor, only a patient that has had a successful experience. Also, there is no guarantee that even if you follow these tips that this augmentation will work for you.
Understand the augmentation strategy. Naltrexone has only been shown to augment SSRI type antidepressants. Work with your Dr. to select an appropriate SSRI for you. If you have been around and around the SSRI loop, choose the one that worked best or had the least side effects. You and your Dr. should review the following links for background information.
Augmentation of Antidepressants with Naltrexone
http://www.dr-bob.org/tips/split/Aug-antidep-with-naltrex.htmlUS Patent 5512593: Composition and method of treating depression using natoxone or naltrexone in combination with a serotonin reuptake inhibitor.
http://www.patents.ibm.com/details?pn10=US05512593Dry out. I believe you can have very unpredictable results if you are on any other medications. Knowing my sensitivity to meds, I tapered off all medications I was on and “dried out” for 2 weeks. It can be nasty, but then you are starting with a clean slate. Again, work with your Dr. to do what is right for you.
Start the SSRI first. After the drying out period, I took the SSRI medication by itself for 10 days to let the levels stabilize. Again, your Dr. can help determine the time period for your particular med.
Add the Naltrexone slowly. The ultimate target dosage for Naltrexone is usually 25 or 50 mg per day, but start out very gradually. I broke a single 25 mg tablet into 8 fragments and sorted them by size. I took the smallest the first day, and so on, and then broke another into larger fragments and continued up. If things get tough, stay at the same fragment size for a few days until you system adjusts.
Wishing everyone my miracle… Wayne
Posted by JohnL on September 19, 1999, at 11:42:48
In reply to Naltrexone Augmentation Tips, posted by Wayne R. on September 19, 1999, at 10:56:16
What amazing timing you have Wayne. I've had bad luck with augmentation of Prozac recently, mostly due to oversensitivy of side effects...tinnitus, hand tremors, whatever. I have enough leftovers to open a pharmacy. Where to go next is confounding. Too many choices. I know my psychiatrist isn't much help, because he is at odds just as much as me. He knows only trial and error will tell. He keeps me safe in choices, but can't offer much direction as to what to try. However, he has read up on Naltrexone and is very interested in it.
He read all the tips I brought him from your posts, and then also heard reports in the field of similar success stories. I saw him a week ago and he reiterated that of all the choices I have, he still thinks Naltrexone is the most intriquing. It's at the top of his priority list in the myriad of choices. It's been in the back of my mind. I started Naltrex when I started Prozac, but stopped because it was too hard to get used to both simultaneously. Now that I'm stable, and you've unknowingly given the knudge to try it, I think I will. My doc fully supports the idea and hopes it works because he may try it with other difficult patients. Great timing you have. Will use your tips.
Question though. How does Naltrex work? I mean, it is an opiate receptor antagonist. I understand it blocks those receptors, but what is the net result of that action? Does it stimulate the body's own production of natural opiates? I like to know what the drug I take is doing. I don't understand what it does. Any help on the technical side here? And again, thanks for your concern for all of us and sharing a potentially life renewing approach.
Posted by Janice on September 19, 1999, at 16:38:37
In reply to Naltrexone Augmentation Tips, posted by Wayne R. on September 19, 1999, at 10:56:16
This is so kind of you to come back after you're feeling so well to share your story and information with us. I'm so happy for you. I can tell by the way you write you seem at peace and are capable of enjoying yourself. I am keeping Naltrexone in mind, and will be talking to my psychiatrist about this eventually. Janice.
Posted by Wayne R. on September 19, 1999, at 16:51:33
In reply to Re: Naltrexone Augmentation Tips, posted by JohnL on September 19, 1999, at 11:42:48
John, I am anxious to know how you make out on the next try. I just wish I could wave a wand and have this work for everyone. As to how Naltrexone augmentation works... I cannot find anything more than speculation. Even Dr. Dante, who seems to have the most experience, has not been able to get any clear data from other professionals. Part of the problem is that the technique is still obscure and has not been subject to much study. I look forward to the day when there is more understanding and would love to see a test that would show who would benifit from the augmentation. I too am one that always wants to understand what makes something work, but I must say that with Naltrexone I don't really care how! I am just glad I finally found something that does. Wishing you the best... Wayne
Posted by jamie on September 20, 1999, at 2:59:09
In reply to How does Naltrexone work?, posted by Wayne R. on September 19, 1999, at 16:51:33
Wayne. What kind of side effects can be expected early in treatment? What side effects can be expected later when have been on 25mg for a couple months?
Posted by JohnL on September 20, 1999, at 3:42:53
In reply to How does Naltrexone work?, posted by Wayne R. on September 19, 1999, at 16:51:33
Alright Wayne, here we go. My psych is psyched. Usually if I'm going to have trouble with a drug I'll know it right away. First dose was quite benign (1/4 pill). Here we go. Save me a seat at the Naltrexone Club.
Posted by Wayne R. on September 20, 1999, at 6:49:34
In reply to Re: Naltrexone Side Effects?, posted by jamie on September 20, 1999, at 2:59:09
Jamie, I am afraid that I have very little information regarding side effects. I personally experienced muscle aches in my shoulders and neck during the ramp up period. This gradually went away over a period of some two weeks. Other than that I consider it to be side effect free for me. I don’t have specifics from other people who tried naltrexone, but it sounded pretty nasty for some. I expect that some started too fast and for others there were other meds involved which could have been part of the problem. So… like most meds the side effect profile can vary widely by person. Best regards, Wayne
Posted by ruth on September 20, 1999, at 7:56:02
In reply to Re: Naltrexone Side Effects?, posted by Wayne R. on September 20, 1999, at 6:49:34
Wayne,
do you think it's possible to use naltrexone for
other booster reasons other than poop out? For
instance, say I wanted to take a smaller dose of
prozac--10 mg's--but normally that's not quite effective
enough for depression--could I add naltrexone as a
booster so it would boost the effect of the low
dose of SSRI?
Posted by Wayne R. on September 20, 1999, at 12:11:14
In reply to Re: Naltrexone as a booster, posted by ruth on September 20, 1999, at 7:56:02
Ruth, I honestly do not know if naltrexone can act as a booster to allow lower SSRI dosages. You may want to review the patent link in my earlier post to see if there is any mention of that possibility. Wayne
Posted by JohnL on September 20, 1999, at 17:13:16
In reply to Naltrexone Augmentation Tips, posted by Wayne R. on September 19, 1999, at 10:56:16
I first read about Naltrexone augmentation in Dr Bob's Tips. I will never forget, and it actually crosses my mind about every day, what the first trial patient said to the doc after 4 weeks...she said something like this..."Doc, I was playing badmitten with my family today and suddenly realized I was having fun. I've never felt that before."
That says it all.
Posted by Andy on September 24, 1999, at 9:17:52
In reply to Re: Naltrexone Augmentation Tips, posted by JohnL on September 20, 1999, at 17:13:16
> I first read about Naltrexone augmentation in Dr Bob's Tips. I will never forget, and it actually crosses my mind about every day, what the first trial patient said to the doc after 4 weeks...she said something like this..."Doc, I was playing badmitten with my family today and suddenly realized I was having fun. I've never felt that before."
>
> That says it all.John L--I'm quite intrigued by all this. Thinking of trying it. How is it going for you?
Posted by Noa on September 24, 1999, at 13:06:12
In reply to Re: Naltrexone Augmentation Tips, posted by JohnL on September 20, 1999, at 17:13:16
Please keep us posted, if my current cocktail doesn't continue to show improvement, it is nice to know there are other options.
Question: is it just for SSRIs or can it augment SRIs like Effexor?
Posted by Wayne R. on September 24, 1999, at 16:03:57
In reply to Naltrexone--you guys have caught my attention., posted by Noa on September 24, 1999, at 13:06:12
> Question: is it just for SSRIs or can it augment SRIs like Effexor?
I think the most definitive answer will come from the patent link that I included in my original posting. Wayne
Posted by JohnL on September 24, 1999, at 16:16:04
In reply to John L--How is it going, posted by Andy on September 24, 1999, at 9:17:52
> > I first read about Naltrexone augmentation in Dr Bob's Tips. I will never forget, and it actually crosses my mind about every day, what the first trial patient said to the doc after 4 weeks...she said something like this..."Doc, I was playing badmitten with my family today and suddenly realized I was having fun. I've never felt that before."
> >
> > That says it all.
>
> John L--I'm quite intrigued by all this. Thinking of trying it. How is it going for you?Week one is history. I like Wayne's tip of breaking the pill into pieces. I have found I can take nearly the full 25mg dose by taking it in pieces three times a day. Side effects for me seem to be mild... mild dry mouth, increased energy (almost hypomanic, except physical, not mental), mild hand tremors, mild decrease of appetite, slight confusion/spaciness if I take too much at one time. I did not research this one before trying, so I had no idea what to expect as side effects. I'm happy there have been no sexual side effects at all. So far so good. Just waiting patiently for the day I feel a difference. Supposed to take 2 to 5 weeks. PLeeeeeeeeze let this be the one! :) It crossed my mind that this might have other benefits not previously mentioned...increased energy and decreased appetite...a great profile for those concerned with weight gain on SSRIs.
Posted by jd on September 25, 1999, at 23:04:24
In reply to Re: John L--How is it going, posted by JohnL on September 24, 1999, at 16:16:04
John wrote:
>It crossed my mind that [naltrexone] might
>have other benefits not previously >mentioned...increased energy and decreased >appetite...a great profile for those concerned >with weight gain on SSRIs.Definitely... I tried naltrexone augmentation this spring using Wayne's slow-start protocol. I'm hypersensitive to meds and finally had to discontinue it (sadly, never even got above 5mg/day), but I noticed a seriously decreased appetite and increased intensity and "drive" once I got past some dysphoria at the outset. (In fact, the "drive" wasn't always that pleasant, one of the reasons I stopped!) The appetite-suppressing aspect isn't surprising given that it's an opiate-blocker: there's been some controversial testing of it for bulimia and even obesity. Hope your results resemble Wayne's!
best,
jd
This is the end of the thread.
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Dr. Bob is Robert Hsiung, MD,
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