Introduction

I have had a long journey with chronic illness. Diagnosed with Hashimoto's thyroiditis at age 9, I have been on daily medication for it since. My issues with IBS started even earlier and, in my early 20s, I was diagnosed with gluten intolerance (and eventually Celiac disease), which began a long series of ever-more-restrictive dietary interventions until I ended up obligate carnivore in 2017.

Likely because of chronic disease issues and difficult childhood experiences I've also been perpetually alienated from my body and prone to dissociation to cope with difficult emotions. The degree, how long it had been a part of my life, and how much it's affected my ability to be present and connected to my body only recently became clear to me.

Enter Low-Dose Naltrexone (LDN).

Understanding Low-Dose Naltrexone (LDN)

Naltrexone is a medication typically prescribed to treat opioid addiction and alcoholism at doses in the 50–150mg (oral) range. For these patients, it reduces or eliminates reward effects from these substances, as it is an opioid agonist (meaning it binds to opioid receptors and blocks the effects of opioids—although this isn't the full story and it also acts as a partial agonist).

Low-Dose Naltrexone (LDN) is a treatment protocol that uses doses in the 0.5–5mg range to treat autoimmune disease, chronic pain, and other conditions. In low doses it behaves almost like an entirely different drug. It's thought to work by modulating the immune system and increasing endorphin production, though the exact mechanism isn't well understood.

I began an experiment with LDN in May 2024 to see if it would help with my autoimmune symptoms.

A reluctant patient

I've known about the LDN protocol for many years but had been reluctant to try it. I held onto a core identity of being a person who didn't do drugs for a long time. This extended to a general aversion to prescription drugs, but more recent life experience caused me reevaluate and let go of this identity.

A break-up last year and a health scare this year led to a significant reevaluation of my life and priorities and I began to reconsider LDN as part of this upheaval. My mom also started LDN last year and had positive results with it, though she dropped it for a while after a neurologist she was seeing made comments about it in her chart as if it was dosed for opioid addiction. This seems to be a common issue with doctor's and off-label use of common drugs and may be a sticking point for those of you who want to experiment. Fortunately, she's since restarted it.

The experiment begins

I began my experiment with 50mg Naltrexone tablets that I broke up and dissolved in 50mL of filtered water. Naltrexone evidently dissolves quickly and mixes evenly in water. I started my dose at 0.5mg/0.5mL using a 1mL syringe and titrated up to a twice-daily dose of 2.5mg over a couple weeks. I noticed active effects with the first dose that increased noticeably as dosage increased.

Onset started with a mild runner's high that lasted for a few hours after dosing—a sort of general sense of well-being and coziness. This effect dominated my first few doses, though unfortunately it stopped after the honeymoon period after the first week or two.

Passive effects were more subtle and took longer to notice. I have a reinvigorated food reintroduction experiment this year—spurred by gut improvements after I started taking the Seed probiotic a couple years ago—that's been running alongside the LDN experiment. It's been so successful that I have yet to have a significant negative reaction to any reintroduction food I've tried.

It's difficult to conclusively attribute this to LDN, as it's far from my only intervention, but given its purported effects on inflammation and chronic gut inflammation and impaired gut barrier are at the root of my food issues, it seems likely that LDN is playing a beneficial role.

Date	Thyroglobulin antibodies (TgAb) (IU/mL)	Thyroid Peroxidase Antibodies (TPO) (IU/mL)
2024-01-24	1 (<= 1 UI/mL)	51 H (<= 9 UI/mL)

Thyroid antibodies are likely a good marker to track for LDN's effectiveness. Mine aren't particularly high at this point (high results can be in the thousands)—both because my Hashimoto's is broadly well managed and because my thyroid has been destroyed for decades—but I will follow up with additional testing in a few months to see if there's been any change.

The really interesting active effect became noticeable as I increased my dosage.

Confronting dissociation

It wasn't until I started doing closer research going into my experiment this year that I discovered LDN's effects on dissociation. Due to its impacts on opioid signaling it appears to essentially limit access to the dissociative state. There's been some research into its use in therapy for dissociative disorders. I found these two presentations via Reddit that were helpful in understanding the effects:

• Treating Mental Health issues using LDN as an adjunctive to Psychotherapy and as a stand-alone therapy (Galyn-Forster)
• Low Dose Naltrexone Traumatic Stress Dissociative Symptoms and Consciousness (Lanius)

I recommend reading through both of them, but the highlights:

• Dissociative symptoms include dissociative amnesia, depersonalization, derealization, and identity confusion often brought on by flashbacks. Broader symptoms include affect dysregulation, somatic symptoms, and alexithymia.
• Dissociative symptoms can be associated with PTSD, CPTSD, dissociative identity disorder, BPD, and other trauma-related disorders.
• LDN in the context of dissociative symptoms may help with more clearly perceiving both surroundings and inner states, improves assessment of reality and managing it, improves somatic perception, and improves emotional regulation.
• LDN may increase anxiety and avoidance symptoms as difficult emotions become harder to ignore.
• A "stoned" feeling is common due to increased receptor sensitivity with ongoing stress response (the runner's high I described above).
• Can manage adverse effects by lowering dose and patient-driven dosing.

My first major experience of its dissociation effects came after some conflict where I was physically shaking during a conversation. I realized partway through that 1. I was having an emotional flashback (my upcoming post on Complex PTSD by Pete Walker will cover this in more detail) and 2. I was feeling the full emotion without access to my usual dissociative escape hatch.

This was not a comfortable experience. Used to being able to fake stoicism and equanimity with dissociation I was suddenly bereft of this tool. The experience was overwhelming, but I managed to get through it with some support from my conflict partners and the emotional flashback passed.

The discomfort was a good opportunity to get used to processing uncomfortable emotion in real time. I've had a few more experiences where I'd typically retreat into dissociation (in the past, not even realizing what was happening) and been able to (or been forced to) stay more present.

I also discovered napping is actually serving as a frequent dissociation strategy for me and LDN also reduces my ability to access this. My integration of these experiences and my new baseline is ongoing.

For some, LDN removing dissociation is going to be like pulling the floor out from under you. If you are not prepared to confront your full uncomfortable emotions and past trauma I do not recommend starting LDN or if you do start very slowly at a low dose (maybe lower than 0.5mg). Anyone with strong trauma should work with a therapist to plan LDN use and manage the effects.

Finding the right balance

Dosing can be tricky with LDN, with small changes having large effects and managing 'undesirable' active effects is sometimes difficult. Most protocols recommend taking it before bed, starting at 0.5mg (or less) and titrating up to 0.06mg/kg of body weight and stopping or backing off if side effects become too much or if you start having negative effects. Vivid dreams and other sleep disruptions are a common complaint with nighttime dosing.

Daytime dosing sometimes comes with complaints of anxiety and uncomfortable emotional disruption. In my opinion, this is actually the drug working as expected on dissociation and the difficulty comes from not being equipped to manage or not understanding what is happening. I suspect a lot of people with autoimmune issues have some level of trauma and dissociation (the cause probably runs both directions—trauma causes autoimmune issues, autoimmune issues cause trauma) and thus this is a common issue with LDN.

For many, simply understanding what's going on and preparing yourself to confront difficult emotions is likely enough to manage the side effects (and confronting them is an important step in healing trauma!). For others, it may be necessary to back off the dose or stop entirely, especially if professional therapeutic support isn't available and you feel out of your depth.

I started my experiment with nighttime dosing since that is the most commonly recommended protocol, but after discovering the extent of the dissociation effects I switched to twice-a-day dosing to get the daytime benefit. However, the anabology post on LDN recommends taking it in the morning for best effects to help with healing and to avoid sleep disruptions. Morning-only dosing is what I've landed on for now.

The ongoing journey

The effects so far have been very promising with improvements to mood and clarity of thought and a general sense of well-being. While acutely uncomfortable, the dissociation effects have been productive for my mental health and close relationships.

I firmly endorse LDN as a treatment worth experimenting with and wish I had started it 10 years earlier.

I plan to follow up with additional testing in a couple months (and probably again next year) to see what effects LDN has had on my thyroid antibodies and other health markers and will continue paying attention to longer-term impact to energy levels, mood, psychological state, gut health, and overall health.