Introducing LDN Treatment
Low Dose Naltrexone - LDN - was developed as a treatment by an unconventional route, with no big pharmaceutical company driving the research and development of the drug. This is seen as a major handicap to the growth of LDN as a treatment for a number of chronic inflammatory conditions, including Multiple Sclerosis, Crohns Disease, IBS, Chronic Fatigue Syndrome, Parkinson’s Disease and Autism among others.
Low Dose Naltrexone is essentially a lower dose of the drug Naltrexone, a synthetic analogue of naloxone which is licensed in the treatment of opiate dependence. The standard dose of 50mg Naltrexone contains a potent antagonist of the mu opiate receptor which completely blocks the euphoria from opiates. It’s very potency reduces its usefulness in addiction treatment as the blockage of the natural endorphins as well as heroin and other opiates, often leads to a low mood and depression. It was a doctor working in addiction that first saw the potential for a low dose of naltrexone to be of use in other conditions.
How did LDN treatment develop?
In the early 1980’s, the discovery of a devastating new illness, acquired immune deficiency syndrome known more commonly as AIDS, left the medical community struggling to cope. AIDS was a deadly blood bourne virus which reduced the immune defences and there was no obvious way to approach this disease. Dr Bernard Bihari was working in New York with opiate addicted patients many of whom had also developed AIDS from sharing injecting equipment. He had shown that AIDS patients had only 25% of the normal endorphin levels. He postulated that although Naltrexone was a relative failure as an addiction drug, its potent action could actually be used to increase endorphin levels.
Most of the endorphins are produced between 2.00am and 4.00am by the action of the pituitary and hypothalamic glands in the brain. Bihari used small doses of naltrexone (1.5mg to 4.5mg) to suppress endorphin levels initially which then provoked a rebound increase in endorphin production. The theory seemed to work as a clinical trial and numerous case studies showed better outcomes and significantly better CD4 counts. Although Dr Bihari did carry out some research, he found it difficult to get this research published however and apart from some poster presentations did not lay the research groundwork for others to build on.
LDN treatment for Multiple Sclerosis
In May 2000 Dr Bihari reported that four patients with Multiple Sclerosis - MS had shown a surprising and significant improvement in their conditions after LDN Treatment. Dr Bihari postulated that the reason for this improvement was due to the same mechanism as in the AIDS patients, an improvement in the immune system due to an increase in endorphin levels. This was hugely controversial as the conventional treatments for MS are generally immuno-suppressant so the immune boosting explanation for LDN’s mode of action seemed to be a contradiction. Without any substantial research to support his hypothesis, the reaction of the majority of neurologists was to dismiss both the idea and the drug.
LDN will not go away..
LDN is perhaps one of the first of a new generation of drugs which has been promoted and preserved by the MS community itself. LDN would just not go away.
Despite rejection by the vast majority of MS specialists and without a research base to build on, the patients who could possibly benefit from the drug kept it alive one way or another. The internet has played a vital part in this incredible story as patients from across the globe compared success stories and fueled the desire to try a treatment that was not being offered by their GPs or Neurologists. It was no wonder that they were keen to try a treatment which was relatively non-toxic and was also effective in two of types of Multiple Sclerosis, primary and secondary MS, which were not suitable for conventional treatment.
The interest in LDN treatment would not go away but the struggle to get a prescription and a prescriber was a considerable challenge for most patients wishing to access this form of treatment. This difficulty has led to some less than optimal practices such as internet or telephone prescribing of the drug without a face to face consultation. For patients desperate for access this treatment these routes of prescribing were a “Godsend”, but for the reputation of the drug and therefore its wider application, this form of prescribing was damaging.
The only real way of getting this treatment to a wider patient group is to involve more medics which the internet prescribing etc was making less likely. Doctors were only going to be interested in being involved in the LDN treatment of patients if it could be shown to be based on science and research. Without a pharmaceutical company funding this research it is difficult to give this security to doctors to encourage involvement in prescribing this drug.
But LDN still refuses to go away. Despite the reluctance of conventional medicine to engage with this treatment there is a dynamic that keeps this treatment going.
Why will LDN not go away? The only reason for this can be the fact that this treatment works for the patients on the ground. There is no other real explanation for its popularity among people with nothing to gain but improved health. How can the medical profession completely ignore such a potentially effective treatment for such a devastating and difficult to treat condition as MS?
Our LDN Treatment website has been set up to encourage greater medical involvement in the prescribing and research of LDN. In partnership with some of the most influential MS charities, LDN Research Trust, MSRC and MS Trust, we aim to improve the status of LDN to ensure that this treatment becomes available to all patients with MS and other conditions that may benefit from access to LDN.
One of the main obstructions to the understanding of how LDN works is of course the lack of research. The endorphin mechanism of action is a possible explanation for its action in MS but it is not the only theory of how it may work. More research is required.
