My new EMDR T has training and experience with DID clients, but none apparently like me. We haven't started processing yet. I'm 4 or 5 sessions in and we're still doing intake work.

Today, she suggested the possibility of medicating with an opioid antagonist (naloxone or naltrexone), and she gave me an article on it by Ulrich. F. Lanius, which is a chapter from Robin Shapiro's 2005 book EMDR Solutions: Pathways to Healing.

The naloxone (injected) and naltrexone (pill) are typically prescribed for heroin addicts because it blocks heroin's ability to bond with the brain. But apparently it can also prevent dissociation?

I'm just wondering if anyone else has heard about this or tried it. My T and I are going to have to work out details because she can't administer an injection of naloxone, so might have to meet her at a psychiatrist's office or something.

On one hand I'm excited that this could be something that might work for me; on the other hand, I'm not sure what to think when the EDMR T with DID experience suggests we try something she's only read about. I guess it's really that bad.

Anyway, thought?

Cant

I looked into this in 2007 for a dissociative client who refused to try EMDR therapy. Ulrich wrote this to me:
"I've found that low dose (eg. between 3mg to 5mg bid, depending on body
weight) is a good place to start. If necessary and there's a lot of
dissociation during the day, it's ok to add a third dose in between the
morning and evening dose. There appears to be a non-linear dosage effect
with very high and very low doses working optimally but I do not know as yet
where the cross-over is. The low dose is better for stabilization and long
term attachment issues, whereas the high dose works well for just trauma
processing on a prn basis. However the high dose definitely has side effect
potential (usually nausea and vomiting)."

And then I asked my colleague Bessel van der Kolk, MD (again in '07) who said:
"I have tried it on about 50 patients and have slowly abandoned it, because the reults seemed to be so unpredictable. But I certainly am open to hearing more success stories, and some impression about for whom it works and for who not. Indeed, touch , focusing techniques, breathing and tapping have pretty much taken the place of Naltrexone in my practice."

Anyway, the three other psychiatrists with whom I spoke back then were unimpressed with the results, and one (who had used a higher dose in a client with cutting behavior) said: " I can tell you there was an acute withdrawl reaction from herbendogenous opoids which was difficult for this patient."

I suggest you and/or your T (and psychopharm) speak directly with Ulrich to hear about his latest research in this area.

I don't know what you mean when you say your T has training/experience with DID "but none apparently like me." Have you considered a consult (for you and your T) with an EMDR therapist who's an expert in DID? If I knew where you live I could give you some names.

Doc,

Thank you for responding. I'm interested in trying this to see if it might work for me, not just with the EMDR processing but also with the day-to-day dissociation issue. I cycle through three self-states: my primary self; a sexual acting out self that seeks to recreate the abuse in unhealthy and time-consuming ways; and an emotional state that contains my affect response.

If my acting-out self understood my affect self, I don't think he would be turned on by what he's turned on by.

I'll reach out to Ulrich and see what he says.

As for your confusion with what I meant by "none apparently like me" -- what I meant was that she has training and experience doing EMDR with DID clients, but has yet to medicate any of them over her X years of practice, so that means I would be the first, which means she sees something in me that she hasn't seen before, I think.

Thanks again.

Cant

Update: There's no email address on Ulrich's website's contact page, so I left him a voicemail.

Update:

Starting my low-dose naltrexone today. Just ingested my first 1 mg tablet.

If someone is thinking about doing this, you'll need a compounding pharmacy to make the doses for you.

Hope this works.

Cant

Hey Cant, how is going with you and therapy?
Have you seen some changes related to day to day dissociation?

Pero

Hi Pero,

Not yet. I'm going up on dosage very slowly, as recommended. Today, I'll be on 8 mg (I took 4 this AM and will take 4 tonight).

I haven't felt anything significant from it yet, and I'm still exhibiting dissociative behavior like online acting out.

I'm hoping that I'll feel something around the 12 mg level, as that will be the cheapest dose because the naltrexone comes in 50 mg tablets that are very cheap.

Getting the 1 mg doses compounded at a pharmacy is expensive. If I get up to 12 and feel a good effect from it, that will be good news.

Will keep you posted. Thanks for asking.

Cant

I came across naloxone in a book I'm reading on healing from abuse. The book is: Psychological Trauma and the Developing Brain. Neurologically based interventions for troubled children by Phyllis T. Stien and Joshua Kendall. The context of the mention is the use of specific drugs to help alter brain chemistry to aid in recovery from abuse. New types of drugs are being introduced in the treatment of PTSD, including CRF antagonists, neuropeptide Y enhancers, drugs to downregulate cortisol receptors, anticonvulsants and anti-adrenergic agents. Furthermore, drugs that block the effects of opiods can be effective in inhibiting dissociative symptoms. The naloxone is discussed in chapter 5, page 138:

http://www.amazon.com/Psychological-Trauma-Developing-Brain-Neurologically/dp/0789017881/



I have found this book to be excellent because it seems to discuss all the varied symptoms I had as a child (and still had as an adult). The book gives treatment (therapy) processes. The book is NOT bedside reading. It is a little bit technical.

Puffer