Re: Naltrexone pharmacotherapy, what do you think?

[Dr. Michael Jenike]

i don't think it is likely that Naltrexone will be helpful with CBT.  here is a negative study that may be of interest:

 

Naltrexone augmentation in OCD: a double-blind placebo-controlled cross-over study

Amiaz R, Fostick L, Gershon A, Zohar J; European Neuropsychopharmacology 2008; 18 (6); 455-461. [Epub 2008 Mar 18]

 

if you want to use a medication that might speed up CBT, you could try cycloserine which has been studied with some positive effects.  here is a reference from our group:

 

Am J Psychiatry. 2008 Mar;165(3):335-41; quiz 409. Epub 2008 Feb 1.

 

Augmentation of behavior therapy with D-cycloserine for obsessive-compulsive

disorder.

 

Wilhelm S, Buhlmann U, Tolin DF, Meunier SA, Pearlson GD, Reese HE, Cannistraro

P, Jenike MA, Rauch SL.

 

Obsessive-Compulsive Disorder Clinic, Department of Psychiatry, Massachusetts

General Hospital, Boston, MA 02114, USA. wilhelm@psych.mgh.harvard.edu

 

Comment in:

    Am J Psychiatry. 2008 Aug;165(8):1050.    Am J Psychiatry. 2008 Mar;165(3):293-6.

 

OBJECTIVE: This study examined whether d-cycloserine, a partial agonist at the

N-methyl-D-aspartate (NMDA) glutamatergic receptor, enhances the efficacy of

behavior therapy for obsessive-compulsive disorder (OCD). METHOD: A randomized,

double-blind, placebo-controlled trial investigating D-cycloserine versus placebo

augmentation of behavior therapy was conducted in 23 OCD patients. Patients first

underwent a diagnostic interview and pretreatment evaluation, followed by a

psychoeducational/treatment planning session. Then they received 10 behavior

therapy sessions. Treatment sessions were conducted twice per week. One hour

before each of the behavior therapy sessions, the participants received either

D-cycloserine, 100 mg, or a placebo. RESULTS: Relative to the placebo group, the

D-cycloserine group's OCD symptoms were significantly more improved at

mid-treatment, and the D-cycloserine group's depressive symptoms were

significantly more improved at posttreatment. CONCLUSIONS: These data provide

support for the use of D-cycloserine as an augmentation of behavior therapy for

OCD and extend findings in animals and other human disorders suggesting that

behavior therapy acts by way of long-term potentiation of glutamatergic pathways

and that the effects of behavior therapy are potentiated by an NMDA agonist.