Originally posted on January 10, 2020.
Are you struggling with your health after using Depo? Are you sick a lot? Do you get a lot of infections? Do you have an autoimmune disease now that you didn’t have prior to using Depo? If you answered yes, this chapter update is for you.
Since publishing THE DANGERS OF DEPO in 2017, there’s been many times that I’ve thought that we might have wrote the book too soon. In hindsight, I still had so much ahead of me. I ended my Destruction by Depo chapter on a high note, at the time, it felt like I had found the answer to my health problems since taking Depo back in 2010. What I didn’t know then was that it would get a great deal worse before it got better and although bioidentical progesterone has been very important in my recovery, it wasn’t all that my body needed.
I know that there’s a lot of us that have been left with health problems that we didn’t have prior to using Depo. I see it every day and have personally experienced Depo’s wrath for almost a decade. There are so many of us that it’s too many to be a coincidence or uncommon effects as they say. On a daily basis, women share their negative experiences, ask questions and join our online communities. I often wonder if all of this will become another #MeToo movement one day.
Many of us struggle on Depo, coming off of Depo and years after stopping it. A constant in our stories is not having been properly informed prior to using the shot. Many of us also share the struggle of prescribing doctors not acknowledging what Depo has done and not helping us get better after Depo's destruction. Often times, health problems cascade into other health problems and before long we’re riddled with chronic, ongoing health issues that eventually destroy our lives. We ultimately end up a shadow of who we once were.
Destruction by Depo, Continued
May 2020 will be ten years since my nightmare began, I took two shots and my health has been deteriorating ever since. I’ve had a few ‘ups’ along the way but I always seemed to crash. Each time that I’d crash it was longer and harder. Eventually I wound up disabled, plagued by numerous and chronic health problems. I started going downhill again just after we released the book. It was a lot to get the project complete and there was understandably a lot of emotion and anticipation leading to the books’ release. Our bodies can’t tell the difference between positive and negative stress, so although we launched the book successfully and I felt a tremendous amount of joy – my body couldn’t take it. It broke down again.
On August 2, 2017 I journaled “We successfully launched the book on July 27, but I’m not doing well. I’m getting bad again – and FAST. Hot flashes and night sweats are severe and more frequent, I’m experiencing A LOT of pain in my knees, neck and back. It burns on the right side of my neck, I have pain points all over my body. My hips ache like they did last fall. I’m so stiff and sore, every time I move my bones crack and pop and make a grinding sound. Heart palpitations have returned. I’m so tired but I can’t sleep longer than an hour at a time. I wake in pain or a pool of sweat. I’m on fire one minute, frozen the next. My skin and hair don’t look good. Old fungal infections in my toe nails have come back. I’m peeing myself again too. The tremors and twitches are back. I can’t cope with the simplest of things. Every little thing exhausts me, I’m extremely fatigued, highly emotional and I get waves of anxiety. I have no energy or focus and my eye sight is blurry. Digestion, bloating, constipation and diarrhea problems are back. Fibro flare ups are taking over. CFS too. I’m intensely sensitive to light, sound, smells and the cold. My thermostat is broken. Everything hurts. I’m not okay.”
My hormone imbalance had reared its ugly head again. Except this time I was on progesterone overload. Back to Anna I went. If you remember, in the Destruction by Depo chapter I wrote about Anna helping me with hormone saliva testing and getting bioidentical progesterone. Tests showed that treatment had become counterproductive. I had over saturated my receptors. In progesterone’s defense, I wasn’t taking the five day break every month. Somehow that part got missed in the mad dash to feel better. My progesterone levels had gone from below 10 to over 5,500! Testosterone was high now too. (When there’s too much progesterone, it can convert to Testosterone, Anna also questioned if my body was clearing the hormones correctly) DHEA was still low. Cortisol too. Estrogen was low but within range yet blood tests indicated that estrogen was below range, so low actually that it was unreadable. Anna said that my adrenals weren’t functioning well and that I was now likely past severe adrenal fatigue. Anna suggested taking a two week break from progesterone and to continue (recently started) DHEA and my vitamins and supplements. She advised me to keep up with my good diet, drinking lots of water and to get lots of rest and to stay away from all stress. She also questioned if I had some inflammation again and suggested consuming turmeric and cumin. It was also recommended that I see an Osteopath and Chiropractor. All of which I did but nothing helped.
I also saw my family doctor again around the same time. He criticized me for going on bioidentical progesterone in the first place. He jumped at the chance to get angry with me. Dr. W was livid. “REAL doctors don’t do saliva testing!” – “You don’t need progesterone, you need estrogen.” – “The reason your health is the way it is, is because you keep listening to them. If you’re going to be my patient you need to stop listening to them and do what I tell you!” This all coming from the man that injected me with poison, refused to connect my health issues to Depo and has had no clue how to help me since. I can’t even begin to describe the frustration that I repeatedly feel with this man. You’d think I’d become immune to his idiocy but I haven’t. I left with a requisition for blood work, a stool sample, X-ray of my neck and back and a prescription for a low dose estrogen patch. I also asked for a referral to see an endocrinologist but to this day haven’t been able to get into see one.
My intention was to go back to bioidentical progesterone as soon as I could. Mortified by synthetic hormones, it took me a few days to put the low-dose estrogen patch on. By the time I started the patch I was back on progesterone at a lower dose with a five day break every month. I was now taking: bioidentical progesterone, bioidentical DHEA, synthetic Estrogen and 8 vitamins and minerals. I was desperate to feel well. It wasn’t long before I stopped DHEA and the Estrogen patch. I didn’t like what DHEA was doing to me (bad acne and facial hair) and I hated how Estrogen made me feel. I had a similar experience on estrogen gel that I used for a period of time after spiraling into menopause in my late 30’s.
That September when reviewing my blood work, I came across an alarming discovery. I also had stage 2 kidney disease! According to my blood work from October 2016, I was clearly within range – Dr. W never mentioned it so the next time I was in to see him, I did. His response came with a scowl “Oh Traci, that’s common. Many people are within this range of stage 2 kidney disease.” He wasn’t concerned in the least. He breezed past it and then nonchalantly told me that my X-rays showed that I have degenerative disc disease, spurs in my neck and osteoarthritis in my back. That too wasn’t a big deal apparently. I had also noticed going through my records that I was past due for my five year colonoscopy, Dr. W agreed that “it might be a good idea.” After this, Dr. W looked at me sternly and said “times up Traci, time to go!” and quickly left the room.
I started taking anti-inflammatory and nerve pain medication around this time, pain had become intolerable and persistent. Daily medications were adding up, I hated depending on pills to get through the day. I still wasn’t sleeping, even with sleeping pills I was up every 30-60 minutes, without proper sleep for such a long period of time I knew that it was adding to my health problems. With each passing day, I felt less and less human. I could no longer do my consulting work, even with a flexible workload and schedule, I couldn’t do it. I could barely get out of bed.
I'm Not Okay
I was going weeks without a bowel movement – my stomach hurt so bad, eating was so painful. I was experiencing involuntary urination, widespread pain in my joints and muscles, muscle weakness, spasms and twitches, I wasn’t sleeping – the fatigue was debilitating, my thermostat was broken again there was never a happy medium I was either freezing cold or on fire and drenched in sweat. Everything exhausted me, Inflammation was high – every movement meant a series of cracks and pops in my bones. Grinding too. My ears were ringing, I had a horrible taste in my mouth that I couldn’t get rid of and I was dizzy every time that I moved. My limbs sometimes got tingly and eventually went numb for long periods of time. My body was incapable of coping with any kind of stress: everything made me feel worse: even opening a can of soup or brushing my teeth was physically challenging. I was sick all the time and old fungal infections had returned. Life was miserable. It just didn’t stop. I was acutely aware that my body was failing. Basic functions didn’t work. No matter what I did, I just couldn’t get well.
By spring 2018 I was experiencing blood in my stool, the timing was favourable since I had requested to get the ball rolling on my past due colonoscopy months prior and was scheduled to see a Gastroenterologist (Dr. E) a few weeks after it started happening. By the time I saw the specialist, my stomach felt like it was permanently distended and I was in an unfathomable amount of pain. It wasn’t uncommon for me to go two, three weeks without a bowel movement. In that initial consult with the Gastroenterologist, Dr. E asked me why I didn’t mention that I had Irritated Bowel Syndrome (IBS) in my consultation survey. It would be another diagnosis that was never addressed. According to the colonoscopy report from 2011, it was identified then that I have IBS. When I went back to Dr. W weeks later, I asked him why he hadn’t addressed the diagnosis from seven years ago, he casually looked the report up and just confirmed the diagnosis. It didn’t seem to faze him, again my health felt unimportant. He never answered my question and I knew it wasn’t worth me getting upset with him about but believe me, I left his office as I usually do – frustrated beyond measure.
It’d be almost a year until I had that colonoscopy. In that year, I continued to get worse. I got shingles and bronchitis again, my immune system was shot – my list of health problems were out of control. The list kept getting lengthier and lengthier. Problems kept piling on.
May 2018: My List of Health Problems
In October, I saw a Neurologist, another referral that I pushed for. Doctor appointments had become my life but I knew I had to keep trying. The Neurologist (Dr. L) ordered an MRI, he said that he wanted to rule out MS. At the appointment, through a series of tests Dr. L informed me that I have a minor tremor, there is some detectable nerve damage and I have minor carpel tunnel. More for my list… great.
It was also around this time that my referral to a pain clinic came through. A friend had suggested I get the referral a few months before. Over the next few months I attended learning sessions, appointments and had various tests done. It was extremely exhausting but I was hoping it would somehow help. It felt like I was in the right place...
In November, I met a doctor at the clinic that would change my life. His name is Dr. F. That December, Dr. F’s report to my family doctor said: “Traci clearly has fibromyalgia with prominent neurosensory symptoms. She has constipation variant irritable bowel syndrome, symptoms suggesting postural orthostatic hypotension and significant trauma history.” His report also read: “Significant in her history is the use of Depo-Provera contraceptive. In 2010 she had two injections and had adverse reactions. This was followed by significant issues. This was the trigger for her decline in her health.” Finally, I was getting somewhere.
The MRI on December 11th ruled out MS but restated the previous diagnoses of neck spurs and degenerative disc disease. The report also showed that I have Spondylosis. Another addition to what seemed like a never ending list of health problems.
I always start the New Year with at least one new goal, 2019 wasn’t any different. My only goal last year was to get well. In January 2019, I created a new get well plan. I put together a new health binder too. I was trying out new habits and doing everything I could to focus on wellness. The year didn’t start out so well, my goal seemed unreachable. Despite this, I pushed ahead, I kept believing that I’d be well.
A Rocky Start to 2019
In February I had that colonoscopy. There were complications during the procedure. They removed more polyps, the doctor couldn’t complete the colonoscopy due to pain. Despite having been sedated, I screamed out in agony. He had to stop. The colonoscopy report ruled out Colitis, biopsies were also taken for “cancer surveillance from known prior pathology” and came back negative. Thankfully.
This colonoscopy (my second) sent me spiralling. Flare ups were continual and worsening. After the procedure, I went several weeks without having a bowel movement, my stomach was so big and hard. I wasn’t just having hot flashes or night sweats anymore, I was overheating every 15-20 minutes, 24 hours a day. None of my pants fit, even leggings were hard to get on. My hands, feet and face were swollen and sore. I was in constant pain. I couldn’t sleep. I couldn’t eat. I couldn’t poop. Everything hurt, all the time. I felt like I was 95. At the time, I was taking multiple medications that only seemed to mask problems and induced new ones. What a viscous cycle I was in. My autoimmune diseases were winning and my body was breaking down. Nothing worked as it should.
I wound up in the emergency department a few weeks after the colonoscopy. The pain was intolerable. I still hadn’t been able to have a bowel movement either. I was getting sicker and sicker, I remember feeling like I needed to be pulled apart, there was so much inflammation that every movement I made was excruciatingly painful. My body was cracking and popping, the stiffness was crippling. I was insanely sensitive to light, sounds and smells, everything startled me. I couldn’t see properly, everything was blurry. My limbs were swollen and tingly – sometimes numb. I was overheating all the time. I couldn’t physically do the simplest of tasks. I had tremors and twitches, I always felt sick, like I had a really bad flu. It wouldn’t stop. At the hospital, they weren’t very helpful. Our healthcare system is such a disaster. I waited six hours, all I got was an X-ray on my abdomen. Remember that weeks prior I had complications with a colonoscopy, I had still not had a bowel movement and I was exhibiting several serious symptoms. They heard fibromyalgia and CFS and I lost all credibility. They put me in the hypochondriac bucket, I felt it as soon as I said it. After another wasted day lost in our healthcare system the emergency doc wrote me a script for a laxative (that I had already tried without success) and another anti-inflammatory medication. I took both the laxative and the anti-inflammatory, I still couldn’t go to the bathroom and although pain was a bit less with the new anti-inflammatory med I was still in a lot of pain that wouldn’t let up. All I could hear whenever I moved (and I mean the slightest movement like turning my neck slightly to one side) was this loud grinding. I got a disability parking pass around this time, I couldn’t believe what my life had become. Something had to change. I had to keep pushing for a way to be well, if I didn’t I knew where my life was headed. I was 41 and mortified that this was it for me.
I started seeing a naturopathic doctor who wasn’t surprised by my experiences after Depo, she shared with me that she’s seen many women over the years struggling after using the depo shot. She began treating me with adrenal and immune boosting IV drips, essential supplements and acupuncture. It all helped but I needed more. I still wasn’t well.
At the pain clinic, Dr. F introduced me to LDN, its short for Low Dose Naltrexone. He told me that it might help with my Fibromyalgia and CFS symptoms but at the time I was miserable having to take so many medications, I wasn’t interested in taking another. By March 2019 though, after the horrific time I had been having since the colonoscopy I was desperate so I looked into it. I was sick with another cold that ended with another episode of shingles. It was literally one thing after another. I researched LDN obsessively. I was overwhelmed by what I was learning. The more that I learned, the more I understood that it could be the answer not only for my awful fibro and CF symptoms (which it was prescribed for) but LDN might also help my failing immune system and other autoimmune diseases I had been suffering with. I also questioned if LDN could help other past Depo users with weakened immune systems.
It took weeks of daily laxatives, over the recommended dosages for me to be able to have a bowel movement. I looked five months pregnant. It had been over a month since I had a bowel movement, when I finally went, I couldn’t stop. I had diarrhea that kept me next to a toilet for nine days. It was absolutely dreadful, when I finally stopped going my whole body felt bruised for days.
It's Like Someone Turned on the Lights
I accepted a prescription for LDN and started it on April 10, 2019. I started by taking 1 mg at bed time. I had a few low grade headaches when I started. I found sleep wasn’t improving and actually worsening if that’s even possible, so I started taking my LDN in the morning. Within days, I felt different. I felt better. Stronger. Clearer. Happier. Within a week, I was off most of my medications. I didn’t need them anymore. The best way to describe LDN’s effects is that it’s like someone turned on the lights. Rapidly symptoms stopped. By the end of the first few weeks on LDN, changes were significant. My very long list of symptoms had vanished and I began to feel stronger and healthier. I knew that I was onto something.
LDN is used in the treatment of cancer, HIV and all kinds of autoimmune diseases. Anything where the immune system is malfunctioning, LDN should be considered. LDN is an oral compounded medication, its relatively cheap and proven very effective for a variety of ailments which is precisely why you’ve likely never heard of it. LDN works by remodulating the immune system, allowing it to function as it should. It blocks certain receptors which increases endorphin production which in turn, modulates the immune system and reduces the growth speed of unwanted cells. These mechanisms also stimulate healthy cell activity and modulate the inflammation response.
As my immune system rebooted, I could definitely feel it. Bizarre things were happening like an infection in my belly button which I had never had before, my ears were draining mass amounts of fluid and I could now wear earrings again without getting an infection. A few months after starting LDN one of my big toe nails that had been plagued by fungal infections for years fell off and the new nail growing in was healthy and it grew quickly.
Seven days after starting LDN I noted that I was no longer crippled in pain, I was no longer waking up because of pain, I was sleeping in longer intervals, stiffness/soreness/cracking and grinding sounds were less and less. I was still a bit stiff but nothing like I had been for months prior. My calves were sore and I noted an increase in muscle spasms but eventually that too went away. I was still having problems with constipation so Dr. F recommended a probiotic. It helped tremendously and after a few weeks, I started going to the bathroom regularly. The swelling and constant bloat went away, pretty soon it no longer hurt to eat and I wasn’t overheating so much. I wasn't crashing after eating anymore either. Around the tenth day, the low-grade headaches went away.
LDN dosing is a bit of trial and error, by the end of April I had doubled my daily dosage to 2 mg. The schedule that I was on was going to increase the dosage until I got up to 4.5 mg. I never made it to 4.5 though – over the course of a few months I went up to 4 mg but ultimately went back to 2 mg because I feel best at that dose. I’ve been on 2 mg once a day since.
Is Your Immune System Out of Whack?
Here’s what I’ve learned about LDN and why I believe it to be something that can potentially help other past Depo users with weakened immune systems: LDN has been called the panacea for autoimmunity. Originally used at much higher doses to treat opioid addicts, in the 80s a doctor from New York discovered that at much lower doses, Low Dose Naltrexone (LDN) is beneficial for those with autoimmune diseases, cancer and HIV. Respectfully, Dr. Bernard Bihari is known as the pioneer of LDN. Every book that I’ve read on the topic includes a salute to his work. And justly so. LDN has changed the lives of countless people suffering with all kinds of immune system diseases.
LDN increases the level of endorphins, endorphins as you likely know are what makes you feel happy, they also relieve stress and pain in the body. Endorphins also play an important role in the immune system. I’ve learned that often times those with autoimmune issues also have low endorphin levels, their immune systems don’t work as they should. The surge in endorphin production does a few different things, they are:
LDN is said to rapidly decrease bad antibodies, restore normal immune system function and in many cases, reverse or delay autoimmunity progression. In my research, I actually found a patent application citing LDN as a multi-purpose health supplement to improve the human condition and preventing multiple diseases and infirmities by stimulating the immune system. The document explains the idea of using LDN as a preventative measure, a supplement one would take to ward off sickness and disease. The document goes on to say “additionally if an illness does become established, the daily naltrexone therapy may reduce or eliminate the need for various medications to overcome the illness because of the enhanced natural ability of the immune system.”
The recommended dose of LDN is typically 0.5 – 1 mg at bedtime for several weeks, followed by 0.5 to 1.0 mg incremental increases over a 6 – 12 week period up to 4.5 mg. It’s recommended that if LDN disrupts sleep to simply take it in the morning. Side effects listed in The LDN Book “can often be prevented by the patient starting at a low dosage and increasing by 1 mg per week…” Most side effects are listed as happening during the initial phase and as infrequent.
In my experience with LDN, I’ve had little to no side effects. I had a few headaches and leg cramps in the beginning and had to switch from taking it at night to the morning because of sleep disturbances (preexisting problem) but other than that, LDN has been miraculous for me. Over the last nine months, I’ve noticed a few times the start of what would have been a flare up lasting several weeks causing tremendous pain but then it stops, it doesn’t worsen like it would before, it quickly improves. This reversal seems to happen overnight, it really is amazing! I've never experienced anything like this before.
LDN has given me my life back. Before starting it I was always unwell and no matter what I did, I couldn’t get a hold of my health problems. One problem after another, symptoms got traded sometimes but they always seemed to resurface with a vengeance. I was sick and tired of being sick and tired, I’ll always be grateful to Dr. F for introducing me to LDN. It may have been prescribed to treat fibro and CFS symptoms but it’s done a lot more than that. I can honestly say that I haven’t felt this good since before I took Depo.
I think it’s important for anyone who’s struggling after Depo to know what I was still going through almost a decade after taking the shot and to understand what LDN has done for me on a symptom by symptom basis. Prior to starting LDN this was my list of symptoms. Beside them, I’ve made notes on level of improvement since starting LDN.
Symptom & Level of Improvement
The majority of my symptoms disappeared within the first few weeks of using LDN. I also stopped getting sick. I haven’t had any colds or infections, knock on wood. I’ve been around sick friends and family and didn’t fall ill – I haven’t been able to do that in years! The last of my symptoms to improve were: fatigue, sleep, stress response and body temperature regulation. It took a bit of time but these too have improved. I went from having a long list of symptoms to virtually none.
My body is finally able to repair itself and fight off illness and infections. The inflammation is gone, there’s no more grinding and immobility due to pain. I’m flexible again. Sure I still have a few aches and pains but nothing like before. It wasn't until it started to get cold outside that I felt some arthritis pain. Again, nothing like before. I’ve also noticed that my hair and nails are looking healthier and are growing again. I can see better, my eyes aren’t blurry. I can think clearer, my memory has improved tremendously. I'm sharper, witter, I feel like this cloud has been lifted off of me. I’m sleeping better than I have in years. I’m able to sleep in longer intervals, I’m no longer waking because I’m in pain or drenched in a pool of sweat feeling like my body's on fire. I have bowel movements regularly and without discomfort. I can eat without digestive uproar. My ears don’t ring, the tingly limbs has gone away too. No more headaches or Fibro flare ups. IBS symptoms for the most part are gone too. I’m not overheating like I used to, nor am I having hot flashes or night sweats. My energy level has increased. I’m not physically exhausted by the simplest of things. I’m no longer so acutely affected by light, sound and smells. Bladder control has improved, I don’t get spells of anxiety and panic. I feel calmer, I’m able to physically cope with every day stresses. My skin looks healthier, tighter, brighter and it heals faster. Finally fungal infections are going away and my nails are healing. I feel years younger. The pain is gone. I don’t feel like I constantly have the flu or bad viral infection. I feel better. Stronger. Happier. Healthier. I feel like I’m in my forties now, not my nineties. I’m so grateful.
If you can relate to any of this, my hope is that LDN can help you too.
Here’s what I’ve been taking:
Prior to LDN, I was on several prescription medications for pain, inflammation, nerve pain and sleep. From that list of prescriptions, all that’s left is the sleeping meds. And over the last several months I’ve weaned myself down to half. I did this by using a supplement called L-Tryptophan. It’s an essential amino acid, your body changes L-Tryptophan into serotonin. Serotonin helps control mood and sleep. One of my next goals is to be off all pharmaceutical sleep medication and to be able to sleep naturally.
Over the holidays, I noticed a few amazing things that my body is able to do again... I burned my hand bringing a cookie tray out of the oven. OUCH – but it healed in about 10 days. (and it didn't get infected either!) This would have taken months in the past. My husband had a really bad cold, I didn’t get sick. There was some holiday stress that snuck up on me but it didn’t rattle me like this kind of stress used to. I also usually get extremely constipated with quite severe IBS symptoms over the holidays with all the big meals and endless treats, this year I had no problems at all. I went to the bathroom regularly. No digestive upset! I’m also sleeping a lot better, I’m actually dreaming again and according to my husband snoring for the first time in years! I wake up feeling rested, no more crippling fatigue.
Using LDN for Recovery
As we discussed in our book THE DANGERS OF DEPO, Depo is an immunosuppressant which means that it suppresses the immune system. In Dr. Poppy’s chapter SHORT AND LONG-TERM SIDE EFFECTS, RISKS AND RECOVERY Dr. Poppy explained to us that Depo acts like a glucocorticoid medication and in activating the glucocorticoid receptors the immune system is suppressed. When the immune system is suppressed we’re at higher risk for infections and disease. It makes sense then that many of us get sick more frequently after using Depo and now may have immune-driven health problems like autoimmune diseases, chronic infections and or illnesses. Here’s why I believe LDN can help past Depo users: Depo decreases immune system function by suppressing it, sometimes our bodies don’t bounce back after Depo and our immune systems are not functioning as they should. We can address other health issues that we might have after Depo, hormones generally take center stage but if we don’t repair our immune system, no matter what we do to be well – good health is not achievable. Here’s where LDN comes in. LDN boosts the immune system, it works by modulating it making the immune system work as it should and once the immune system functions correctly, the body can do what it needs to do to be healthy. After years of pain and sickness, spinning my wheels to get well, I finally I found the answer. Low Dose Naltrexone, LDN. A way to heal the immune system after Depo-suppression. It helped me… maybe it can help you too. And remember: you’re not alone. I understand what it’s like to have your health destroyed by Depo and not know how to get better. Keep going. Stay strong and keep talking about your experiences. If any of this has resonated with you, please consider LDN. It helped me so much. For a list of LDN resources please see below.
Signing off grateful and hopeful that LDN can help you too,
TRACI JOHNSTONE xo
A Note from Dr. Poppy
Naltrexone (name brand Vivitrol in the US, ReVia in Canada) was first synthesized in the 1960s as an opioid antagonist for the treatment of opioid abuse. At a 50 or 100 mg dosage, the medication occupies and blocks the opioid receptor, so that patients using heroin or other opiates will not experience a “high.” It is also used to treat alcohol dependence. At lower doses of 0.5-4.5 mg, however, naltrexone appears to stimulate the opioid receptor, increasing the endogenous (made in the body) production of endorphins. By temporarily inhibiting the opioid receptor with a small dose of naltrexone (now referred to as low dose naltrexone or LDN), usually at night, there is a rebound effect the next day in an increased production of endorphins. Most people are familiar with endorphins as the euphoric effect of aerobic exercise, or “runner’s high.” Unlike the artificial high of illicit exogenous (put into the body) drugs, the body is naturally producing feel-good hormones that do not incapacitate the person in any way. These endogenous endorphins also have anti-inflammatory effects in the body. The drug is not to be confused with naloxone (or Narcan) which is a drug which rapidly removes the opiate from the receptor in order to reverse the effects of opiate overdose. Naltrexone has effects on opioid receptors in both the central and peripheral nervous system. There are three main endogenous opioid peptides: endorphins, enkephalins, and dynorphins. There are five opioid receptors: Epsilon (endorphins), Delta (enkephalins), Kappa (dynorphins), Mu (morphine), and Sigma. Naltrexone blocks all of these receptors. Once the drug wears off, the hypothalamus begins the rebound production of proopiomelanocortin (POMC). This pro- hormone stimulates the pituitary production of beta-endorphins, adrenocorticotropic hormone (ACTH), and melanocyte-stimulating hormone. ACTH in turn stimulates the adrenal glands.
Gastroenterologist Jill Smith has done work in her lab demonstrating the effect of naltrexone on the inflammatory bowel condition Crohn’s disease. Specifically, she identified that by stimulating the mu, kappa, and delta receptors locally, naltrexone reduced the production of inflammatory cytokines in the body (Interleukin 2/6/12, Tumor Necrosis Factor Alpha, Gamma Interferon). Centrally produced increasing enkephalins helped to heal the inflamed bowel. This basic science work was demonstrated to be clinically effective when Dr. Smith conducted a randomized placebo-controlled trial which showed improved clinical and inflammatory activity in patients with Crohn’s disease. Similarly, it has been found to be useful in other autoimmune conditions such as fibromyalgia, multiple sclerosis and many others.
The original work with low dose naltrexone was conducted in the 1980s by Dr. Bernard Bihari, who was interested in the effect of opioids and endorphins in immunosuppressed HIV patients. He identified that these patients had very low endorphin levels and that by increasing
endorphin levels with low dose naltrexone, the patient’s immune system began to improve, fighting off opportunistic infections, and increasing the production of natural killer cells. Research was occurring at the same time on anti-retrovirals such as AZT and unfortunately, money for continuing to conduct large-scale studies of LDN was no longer available.
LDN appears to have a positive effect on fertility. Dr. Thomas Hilgers and Dr. Phil Boyle, practitioners of a form of women’s healthcare called NaPro Technology have used LDN extensively in fertility, pregnant and breastfeeding patients. Specifically, their work and that of similarly trained colleagues have demonstrated clinical benefit in the following patients: premenstrual syndrome/premenstrual dysphoric disorder, endometriosis/adenomyosis, autoimmune patients, PCOS/hyperinsulinemia, dysmenorrhea, diminished ovarian reserve, recurrent pregnancy loss, and chronic pain patients of various etiologies. There is no evidence of teratogenic effect, rather LDN appears to reduce the risk of miscarriage and preterm birth. Multiple studies of opioid dependence have demonstrated no serious adverse effects of high dose naltrexone. Side effects with LDN tend to be mild and include nausea, headache, vivid dreams and sleep disturbance. Insomnia tends to only last one to two weeks on the initial LDN dosage although some patients do have to take it in the morning if these effects are lingering. LDN has to be made for the patients at a compounding pharmacy and generally costs between
$40-$60 a month. Contraindications to LDN would be using opiates at the same time or more than two alcoholic drinks, both of which can cause nausea and vomiting. Normal kidney and liver function are recommended to be documented prior to use, however, there appears to be no ill effects on these systems with LDN. Starting dosages range from 0.5 to 1.5 mg and are increased as needed clinically up to 4.5 mg.
LDN seems particularly suited to those who have experienced long-lasting physical and hormonal effects of Depo Provera. The immune-modulating and anti-inflammatory effects help to mitigate many of the chronic issues that appear to be induced by the glucocorticoid withdrawal effect of Depo. In addition, the stimulation of adrenal function through increased ACTH production would be beneficial for the adrenal dysfunction that many Depo patients experience. While the use of LDN is considered off-label, there is much basic science and clinical experience to support its use. I have prescribed LDN for the last several years and continue to increase the number of conditions I prescribe it for. There are many patients who feel it has changed their life for the better, particularly in regards to its anti-inflammatory and pain control benefits. Others, it seems to have only minor effects. However, given the frequent debilitating effects of Depo Provera and those of many other chronic conditions, I would encourage patients to discuss with their clinicians whether they feel a trial of LDN would be worthwhile. I’m optimistic that it will be the key to turning many patients’ health around.
DR. POPPY DANIELS, MD
If you want to try LDN but your doctor won’t prescribe it you can find a prescribing doctor via these resources:
If you can’t find a compounding pharmacy, check out these resources: