Some autism regimens are stalwarts that continue to demonstrate improvement (ABA). Some fade away – perhaps even to re-emerge (secretin?). Others hang around until more testing is documented (Memantine). Many can cause harm (Zoloft). A few are useful for specific purposes and so they continue to have a biomedical following. Naltrexone treatment falls in the last category.
The medication was approved in the 1990’s for addiction treatments including alcoholism, at a dosage range of 50+ milligrams per day. The thinking is that, if people don’t get high from alcohol and won’t suffer it’s absence, they won’t continue to drink. This is not the same chemical as Antabuse, which turns to formaldehyde and makes you SICK when you drink. Also, it shouldn’t be confused with the morphine antagonists Naloxone and nalorphine.
Nearly two decades ago, Italian researchers wrote, “There is a growing body of evidence that the immune and the central nervous systems interact and reciprocally influence each other… Taken together the assumptions that… the opioid system plays a crucial role in cognitive and immunological functions… and opioid peptides are present in excess in autism; then pharmacological reduction… by treatment with an opiate antagonist might counteract some of the behavioral and immunological disturbances observed in autistic individuals.” With a slightly different ‘low dose’ protocol, improvement was demonstrated “in a subpopulation of autistic children by chronic blockade of opioid receptors with a potent opioid antagonist, supporting the concept of an opioid-immune link in autism.”
In her 2006 report, Dr. Jaquelyn McCandless concluded, “As an effective, non-toxic, non-addicting, and inexpensive behavioral and immunomodulating intervention, LDN is joining our biomedical arsenal to help more and more children recover from autism as well as helping anyone with autoimmune diseases and cancer.” Her paper was entitled, “Low-Dose Naltrexone for Mood Regulation and Immunomodulation in ASD”. Sound like anyone you know?
Dr. McCandless’ protocol calls for specific timing (9-11PM) with a naltrexone-compounded cream (in the 1-1/2 to 4-1/2 mg. range) applied to a sleeping patient’s back or forearms. Once, a dad asked if he should also dance around the bed and chant. Funny guy. Which patients? What dose? What are the positive changes? The side effects? For individual patients, in order to achieve the goal of enhanced communication, doctors sometimes vary formulations, frequencies, and timing based on responses.
In my clinical experience, there is one type of autism that clearly disrupts by affecting the patient’s immune system. (How many other kinds of autism? is the subject of another explanation-post). Also, some oppositional behaviors, similar perhaps to an externally chemically-altered state, appear to benefit from this intervention. The major impediments preventing LDN from more common usage are:
1. It’s complicated and so requires parent education and resources.
2. After starting, the therapy requires tailoring to the patient’s responses and the family situation.
3. Patients don’t usually show immediate improvement, it may take up to 8 weeks.
4. Not infrequently, an apparent deterioration in behavior may occur in the early stages of treatment.
Of course, many biomedical interventions are subject to these same limitations.
That original naltrexone experience did prove significant and sustained improvement for a targeted, though small, population. For parents who wish to learn more about this subject, the Low Dose Naltrexone website is very informative and the Yahoo Group LDN is a great place to communicate with other users.
My discussion can be found here.