Naltrexone & Food Addiction

:huh:
I have _some_ familiarity with naltrexone and _some_ familiarity with the concept of food addiction.

As I understand it, the general consensus (ATM) is that binge eating is comparable to a process addiction, such as gambling, where the abnormal brain activity isn't caused by any specific chemical.

Naltrexone is an opioid antagonist, as you stated yourself. It works on specific neural transmitters and can block cravings for drugs that affect those. This is why it is recommended in recovery from downers but not from uppers. I can't imagine how it could help with a process addiction...

ETA : I'm not a health professional. If you are, feel free to correct me and tell me to shut up.

I'm not a health professional, nor will I claim to be, so no worries there! I'm just pursuing a career in neuropsychology, so I tend to read up a lot on these sorts of things, in my personal time. :c

Really? Where did you read that the abnormal brain activity is not involved with any specific channel? I've always read about addictions, concerning their involvement with the mesolimbic pathway (also known as the reward pathway, which involves the transmission of dopamine). So, I'm curious to see what research you have, about this! If you have any (reputable) research, please do send it my way.

Granted everything in these fields are merely theories..... so they can down the road be easily proven wrong a year from now, and we could all be completely wrong in our assumptions. However, the most up-to-date theory of addictions that I've read up on concerns the activation of the reward pathway, regardless of the stimuli (whether it be a behavioral addiction, or not). Obviously there are substances that activate that pathway more than others (such as the non-process addictions, as you call them), but that doesn't mean that behavioral processes cannot be just as addicting, on a neurochemical level. When it comes down to it, drugs are not addictive because their effects 'feel good'. They're addictive because of how they stimulate the reward pathway, and their 'feel good' effects are things that the addict's body conditions, to associate with the substance at hand (which is a loose theory of cravings as well, in substance addictions).

There are obviously various opinions on the topic, but there recently have been articles about the potential for addiction in food. If I remember correctly, sugar is one of the substances within food that is rather addictive, and comparable to heroin, in terms of how addictive it is. Obviously the 'high' from sugar does not produce an altered state of consciousness (as one has in heroin), but it's just as active within the reward pathway.

That being said, I'm always open to learning more about opposing view points, so send send send information if you have any!

:huh:

I just gladly discovered that I could add animated smileys to my responses, so herrow! :drinker:

As I stated clearly, I am strictly a layman in this, more so than you in fact...

This really could be debatable, since I'm merely an undergraduate psychology student, with a small obsession with neuropsychology. I'm trying to get into my school's biopsychology track, so that I can actually study neuropsychology, before I graduate in the fall (being a psychology major, none of my courses really cover the topic). SO, yeah. I am by no means a professional either.

Indeed, all addictions work on the reward system, but different drugs work differently on it. The difference between behavioural addictions and chemical ones, as I understand it, is that the former over-stimulate natural reward mechanisms whereas the latter use external agents to force your brain to release dopamine.

Do you have any articles I can read later, on this? Some substances block dopamine while some increase dopamine....but in the end, it's still good ol' dopamine being manipulated, if I comprehend this all correctly.

The text is freely available but quickly went over my head. What I take away from it is that the main neurochemical imbalance observed in eating disorders involve dopamine signaling and the D-receptors, specifically D2.

The summary alone of the article actually goes to say that the genetics of those with addictions are similar to/the same as those with obesity: "Increasing amounts of data from human imaging studies, together with genetic analysis, have demonstrated that obese people and drug addicts tend to show altered expression of DA D2 receptors in specific brain areas, and that similar brain areas are activated by food-related and drug-related cues."

The D2 receptor - the same one that you list as being involved in eating disorders - is the very same receptor believed to be involved in alcoholism, drug addiction, etc. (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1295855/). Seeing how the co-morbidity is so high between eating disorders/substance abuse, it makes sense in a statistical sense, as well as in a neurochemical/genetic sense that treatments with a high success rate in addicts would also have a high success rate in those with eating disorders.

This genetic realization - that eating disorders and specifically alcoholism are on the same gene - was actually pretty recent, and pretty exciting! If you're actually interested in learning more, there is a theory of Anorexia Nervosa, in which the anoretic becomes addicted to their body's own endorphins (spinal taps of anoretics have shown that they contain incredibly elevated levels of endorphins in their spinal fluid, in comparison to those not restricting; it's believed that this is due to their high levels of D2 receptors). There are similar theories for Bulimia Nervosa, as well. These theories all center around the idea that eating disorders are at their root, addictions. I don't know - the theory of eating disorders being addictions always made plenty of sense to me, which is why I was so happy to learn about the genetic discovery, concerning D2 receptors.

Opiates bind to the opioid mu-receptors and only indirectly affect dopamine. Naltrexone was designed as an opiate antagonist and blocks opioid receptors, which as far as I can tell aren't involved in eating disorders.

Dopmaine is the pleasure hormone in a way, since it motivates us (using that pleasure) to continue habits we pursue. Opioid mu-receptors are found, within the VTA (ventral tegmentum area) as well, which is how they are so closely tied into dopamine's activity within addiction. The VTA is a part of the midbrain, which houses a ton of dopaminergic cells, and is therefore believed to play a crucial part in addiction. When people have a binge episode, it causes a spike in dopamine, and therefore causes a spike in opioids. If somebody is unable to derive any 'opoid- pleasure' from their drastic intake of food (which is what Naltrexone does), their body will slowly but surely break down that association.

That being said, I did stumble on a paper which suggested that it had been used with some success against pathological gambling, so IDK... Still, I saw no indication that it has been used in treating eating disorders or of any consensus that it is effective against behavioural addictions...

It's harder to find it's usage in eating disorders, since it's an off-label use. If you search forums enough though, you'll find that there are people who have found relief from it, in terms of their compulsive eating. Many of the people who stopped taking it (that I rather talked to/read about) did such because of the side effects not being worth the benefit they derived from the medication. Of the people whose symptoms parallel mine though, they saw relief in their behaviors, and I've already found tremendous relief in my behaviors as well. There are also a few studies being rolled out about Naltrexone's usage in eating disorders, but they're not very high in reliability since most of them are so spankin' new that they haven't had the time to be reproduced.

In all honesty, the mental health professional prescribing me this medication is my third opinion: the first two doctors I saw kept diagnosing me with disorders that didn't really match up with my symptoms, prescribing me illogical medications in reaction to my ever-changing diagnoses, and didn't really listen to me. The reason I trust this professional is because she is thoroughly educated in terms of medication, and (unlike most other pdocs I've seen) she truly listens, when I describe my symptoms/side effects of medications I'm on.

I also have no problem stopping the medication if it causes any problems, and it's not as though the medication is highly addictive, highly toxic, etc. In comparison to the other medications I've been on in an attempt to cure this binge eating (Ativan, Abilify, Latuda, Lamictal, Topamax, Wellbutrin, Celexa, Trazadone..... the list could go on for hours) this pales in comparison. I'm actually still suffering side effects from the Abilify I took, which I stopped in October (against the advice of my pdoc at the time, whom thought I should continue taking the medication, even when continually increasing the dose was giving me tardive dyskinesia, along with blood sugar problems, and heart problems). So, trust me when I say that I'm a huge advocate for myself, and that I keep an eye on things. If I feel as though something isn't right, I have absolutely no problem pursuing the treatment that I need to get better.

A few 'behavioral addiction' studies, if you want to take a look:
Internet Sex Addiction: http://www.ncbi.nlm.nih.gov/pubmed/18241634
Self Injurious Behavior: http://www.ncbi.nlm.nih.gov/pubmed/22776054
Binge Eating Disorder: http://www.ncbi.nlm.nih.gov/pubmed/7735342
(Since this is a rather new theory, I assume that most of these studies have not been replicated, and therefore don't have a high level of reliability, but I can't speak in terms of their validity).

I AM SO SORRY FOR RAMBLING ON FOR HOURS, and I'm so sorry if my comprehension of any of these things is incorrect! I'm also sorry if my writing/grammar is questionable - I've been working and at work all day, so I'm not really in tip top shape at 12:45 AM to be talking about things of this nature, haha. :x

OP:
I do appreciate your open mind and wanting to learn new things. To clarify, Binge Eating Disorder (BED) is a real thing, food addiction is not recognized in any diagnostic material. (your OP only mentioned food addiction, not BED, which is why I questioned it) There have been studies completed on "food addiction," but there is not enough evidence to warrant an addition to diagnostic material. (this includes sugar) Yes, there are some medications that can be used in conjunction with other types of therapy. However, it seems the jury is still out on the effectiveness of this specific drug that is generally used with a different population. (addictions to alcohol or opiates) I do understand that the brain cannot tell the difference between things and just knows "that feels good," "I like it," "do it again." However, there is so much more to it when prescribing medication for a specific reason or diagnosing a person. It is great to hear that you have found a clinician that listens to you and you are willing to try different treatment options. I do understand the frustration that comes with finding the appropriate treatment method because it should be tailored to the individual.


It seems you have tried over 8 medications with the hope of curing the binge eating. It may be a good idea to look at treatment as a way to manage your symptoms versus curing them. (just a thought?) By all means, nobody here is able to give specifics that will apply to you because we are not aware of your medical history, diagnosis history, treatment history etc. There is a wealth of information out there and I suggest when reading studies, to objectively look at the most recent ones (think 5 years, not 10-20) and if you cannot get enough, you can check out the reference list for additional reading. The basics of mental health can be difficult to grasp and moving on to the more intricate portions is a different ball game. However, you know your symptoms better than anyone else and I applaud you for taking steps to improve your symptoms. I encourage you to continue reading, learning and seeking to understand after your undergrad studies. Again, I appreciate your open mind and wanting to learn new things. Wish you the best.

I know it's not considered a diagnostic requirement, in the DSM-5 (GRRR it drives me nuts that they insist on using the number instead of the roman numerals). I never claimed that it was, and I should of been more clear in my fluid usage of the terms in case others are not really sure of such. For me, the numerous health professionals I've seen have realized that my binge eating is essentially the same as an addiction to food, behavior wise and experience wise. My behavior perfectly fits the concept of the 'functional addict', actually. So I don't comprehend what you mean when you talk about there being more much to prescribing to a person, since my physician knows about my background, knows about the off-label usage of Naltrexone, and feels as though it may be beneficial to my situation? :c

Oh! When I was talking about sugar, I was not talking about anything concerning a diagnostic criteria. I was merely talking about (which you already stated you comprehended) a substance's ability to activate the dopamine reward pathway, and become addictive. I merely used sugar as an example, when it's consumed in large quantities.

I know it's not currently approved for usage with eating disorders, which is why I continually described it as an off-label use. I know that it's an emerging idea they're studying, and by no means something that the FDA is gladly endorsing as of right now. That doesn't mean it's not a legitimate use of the medication though: it's not as though the medication 'suddenly starts working' the minute it's approved by the FDA.

I'm actually holistic, meaning I believe medication should be a very last resort, only used in emergency situations/crises. So, I have tried every other treatment I could afford (in patient, 12 step programs, dialectal behavioral therapy, cognitive behavioral therapy, psychoanalysis [and numerous versions thereof], etc.). So, medication is more so a last resort, than my first option. I'm to the point where this disorder is consuming my life, and my doctor/I have come to realize that it's more so a physical addiction, as I've dealt with the driving forces that caused me to develop the disorder and for some freaking reason, that compulsion is still there? -_-

Thank you for your thorough response, I really appreciate it! I was so confused at first about your smileys, but it was quite nice to discover that there are animated ones on here, haha. :c I've always been a huge advocate for myself, because very quickly (i deal with a lot of disorders considered 'extreme', and a very stigmatized disorder) I learned that if I wouldn't do it, I'd be caught in the system. Being involved with psychology on campus and having friends involved in neuropsychology just made that heaps and loads easier for me.

I'm always open to learning more - I feel like so many mistakes are made in both medicine and social sciences, merely because people are unable to keep an open mind! If anybody sends me research that is reliable and valid, I'll entertain the idea, you know? Obviously I won't always agree with it, but it's nice to have somebody play devil's advocate, merely because we tend to just pursue the research that supports what we believe so it all becomes a self-fulfilling prophecy which gets nobody anywhere.

Thank you! I'm actually about to start applying for graduate schools and I'm SO STOKED. :c

Take care, and thank you again for your comment!