Low-Dose Naltrexone (LDN) Treatment for ASD
by Jaquelyn McCandless, M.D.
Thanks to DAN! doctor Jaquelyn McCandless, author of “Children with Starving
Brains,” for providing this report on a very promising new treatment.
Naltrexone is an FDA-approved drug used as an opiate antagonist for treating
opiate drug and alcohol addiction since the 1970s, available in generic form as
well as in the brand name ReVia in 50mg tablets. At regular dosing to treat
addiction, usually 50mg to 150mg a day, it blocks the euphoric response to
opiate drugs such as heroin or morphine as well as alcohol.
Opioids are known to operate as cytokines, the principal communication signalers
of the immune system, creating immunomodulatory effects through opioid receptors
on immune cells. A popular immune classification method is referred to as the
Th1/Th2 balance: Th1 cells promote cell-mediated immunity, while Th2 cells
induce humoral immunity. Simplistically, the inability to respond adequately
with a Th1 response can result in chronic infection and cancer; an overactive
Th2 response can contribute to allergies and various syndromes and play a role
in autoimmune disease, which most autism spectrum children show on immune
testing. The November 13, 2003 issue of the New England Journal of Medicine
notes: “Preclinical evidence indicates overwhelmingly that opioids alter the
development, differentiation, and function of immune cells, and that both innate
and adaptive systems are affected.” An Italian study done in 1996 by Scifo and
Marchetti attempted to correlate immunological determinations and behavioral
performance in treatment with naltrexone in 10, 20, and 30mg doses in autistic
children, with significant reduction of autistic symptoms noted in 7 out of 12
children. The behavioral improvement was accompanied by alterations in the
distribution of the major lymphocyte subsets, with significant increase in
normalization of the CD4/CD8 (T1) ratio and an inverse ratio of changes in NK
cell activity to plasma beta-endorphin levels. A large body of research in the
last two decades has pointed repeatedly to our endogenous opioid secretions as
playing the central role in the beneficial orchestration of the immune system.
Bernard Bihari, MD, a New York physician studying the immune responses in AIDs
patients, discovered that a very low dose of naltrexone, approximately one-tenth
the usual dosage, boosts the immune system and helps fight diseases
characterized by inadequate immune function. The temporary inhibition of brain
endorphins when given a very tiny dose of naltrexone apparently results in a
reactive increase in the production of endorphins, tending to normalize the
immune system with this elevation, and accomplishes its results with virtually
no side effects or toxicity; naltrexone is considered very safe and has never
been reported as being addicting. When LDN is given between 9 p.m. and midnight,
the body attempts to overcome the opioid block and the endorphins rise, to stay
elevated throughout the next 18 hours. Studies in human cancer patients show
that LDN acts to increase natural killer cells and other healthy immune
defenses, and hundreds of multiple sclerosis patients have totally halted
progression of their disease for up to 8-10 years or more with regular use of
this medication. Restoration of the body’s normal production of endorphins in
those with cancer or autoimmune diseases is the major therapeutic action of LDN,
which needs to be given only once a day between 9pm and 1-2am.
The use of LDN for children with autism spectrum disorders was previously
studied in the 1990s, with researchers using from 5 to 50mg daily or every other
day. In these trials, researchers were looking for opioid antagonism. Panksepp,
Shattock and other researchers noted better results with low doses; studies on
higher doses were more equivocal in children, and non-compliance due to the
bitterness of the drug posed a problem for children who could not swallow
capsules.
For my private clinical studies, Dr. Tyrus Smith at Coastal Compounding created
a very effective transdermal cream. This allowed easy adjustment of dosing (some
of the smaller kids did better with only 1-1/2mg), the bitter taste was no
problem, and the cream could be put on the children’s bodies while they slept.
The cream is put into syringes, with ½ cc providing 3mg for children or 4.5mg
for adults; most adults prefer capsules; both are equally effective.
I completed a preliminary eight-week informal study on 15 of my autism patients
May-June 2006 applying 3mg of LDN transdermally between 9 and 12 p.m. Several
adults participated also, one with Crohn’s Disease and one with Chronic Fatigue
Syndrome using 4.5mg nightly. Parents and participating adults reported weekly
on the results of the treatment.
Eight of the 15 children in this study had positive responses, with five of
these eight having results considered quite phenomenal according to their
parents. The primary positive responses have been in the area of mood,
cognition, language, and socialization. Two small children responded better when
changed to 1-1/2mg dosing. No allergic reactions were noted, and the primary
negative side effect was insomnia and earlier awakening, usually fairly
short-lived. The two adults in the study had very positive responses, with the
Crohn’s participant reporting that she has been in remission since starting LDN
(almost 10 months at this writing).
All of the children in my study were on well-controlled dietary restriction. I
have received reports from the e-lists I monitor of about 5-10% of other
children (not my patients) having side effects such as irritability, agitation,
and restlessness, subsiding as soon as the drug is withdrawn. I queried these
parents about gluten/casein/soy in the children’s diets, as this response is
very likely indicative of withdrawal symptoms of opioid block even though brief.
I suspect that children on a strict GF/CF/SF diet are less apt to show this
response; this has yet to be tested.
The immediate positive mood/cognitive/relating effects seen in many children
starting this intervention is unlikely to be from immune enhancement showing up
so quickly. For other autoimmune studies using LDN, the evidence is that the
optimum immune response can take four to six months. In private correspondence
with earlier autism researchers Drs. Panksepp and Shattock, they postulated that
the LDN therapeutic effect with the rebound of endogenous opioids in the brain
“loosens up” the opioid social-reward systems so children who were not
connecting to the many known opioid based social rewards in the environment
begin to respond to those rewards. Both these researchers emphasized the
importance of positive social reactions being reinforced and enhanced
substantially by social support and encouragement, helping the new behavior
become part of positive behavior modification. A significant proportion of
children upon starting LDN show not only some increased hyperactivity and sleep
changes, but a bout of what seems like “viral activation” in the form of a cold,
fever blister, and other infections. These are usually short-lived, followed by
a burst of improved language, cognition, and socially seeking behavior. Now,
instead of immediately lowering the dose, I am asking parents to use the full
dosage, which seems to cut down this time of adjustment for most of the
children. Some do need to go down in dosage, but I urge parents to try to stay
the course if possible as I suspect the maximum immune benefits occur with full
dose, whereas the immediate social-reward and cheerfulness effects occur on
ultra-tiny doses.
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. As an FDA approved medication, it must be
prescribed and must also be compounded for the tiny dosing required.
Note: I am currently conducting a clinical study aimed at not only ASD
children but their parents, as it is well known that autoimmunity has a strong
genetic component. 80 adults and 26 children are in this 16 week study. Dr.
Vojdani at Immunosciences Labs helped me work out an extensive immune panel for
determining what LDN will do to important immune and autoimmune markers along
with weekly tracking of behavior, mood, and physiological functions. Results of
this study will be reported by June 2006. For more information, see
www.lowdosenaltrexone.org or join Autism_LDN@yahoogroups.com.