LDN and bipolar disorder: 6 FAQs

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Bipolar disorder is a mental health condition characterized by periods of intense mood symptoms. If you have bipolar disorder, you may experience:

Typically, treatment for bipolar disorder involves a combination of therapy and medication – you’ll find more about these below.

Of course, these existing treatments for bipolar disorder may not work for everyone, and some medications come with a number of side effects. This is why researchers keep exploring potential new drugs to help treat bipolar disorder.

One drug currently being studied is naltrexone, a drug typically used to treat substance use disorder (SUD). Some preliminary research suggests that low-dose naltrexone (LDN) may help reduce mood swings.

Below, you’ll find answers to some of the most common questions about naltrexone for bipolar disorder, including why a low dose might be beneficial as part of treatment.

Naltrexone is a drug that the Food and Drug Administration (FDA) has approved to treat alcohol use disorder (AUD) and opioid use disorder (OUD).

It works in two main ways: It helps reduce food cravingsand it blocks endorphin and opioid receptors in your brain.

To put it simply, if you drink alcohol or use opioids while taking naltrexone, these substances will not produce the feelings of euphoria that they usually would.

Some research also supports naltrexone as a treatment for bipolar disorder, although existing studies focus primarily on people living with both SUD and bipolar disorder. This is most likely because the two conditions frequently occur together. In fact, between 40% and 70% of people with bipolar disorder have also had an AUD at some point in their lives.

Although it is common for SUD and bipolar disorder to occur together, only a few studies have explored how treating SUD with naltrexone may affect co-occurring bipolar disorder symptoms.

In a small 2006 study, 34 people with bipolar disorder and AUD took naltrexone for 16 weeks. Participants reported an improvement in symptoms of depression and mania, as well as a decrease in alcohol cravings and drinking days. Also, naltrexone does not seem to cause any major negative effects.

A big self-controlled cohort study from 2021 also explored naltrexone as a treatment. In this type of study, participants report their symptoms before and after a specific treatment. The study authors found that people who took naltrexone to treat AUD or OUD had a 65% lower rate of diagnosis of bipolar disorder than those who did not take naltrexone.

Naltrexone is a hormetic medicinewhich means that different doses may affect you differently.

A regular dose of naltrexone is 50 milligrams (mg) per day. This dose blocks your endorphin and opioid receptors to prevent your brain from releasing too many of these chemicals if you drink alcohol or use other substances.

A low dose of naltrexone is 1 to 5mg per day. At this dose, naltrexone actually increases endorphin and opioid levels, but not as much as alcohol and opioids. LDN can also reduce inflammation in your brain.

LDN is a adjunctive therapy. This means that it helps increase the effects of other medicines, so you will take it together with another type of medicine.

Because LDN research is still in its infancy, experts still don’t know exactly why LDN affects the brain in the way it does. However, the limited studies that do exist show fairly consistent effects.

Evidence suggests that changes in your endorphin levels can contribute to episodes of mania and depression. Therefore, LDN can improve symptoms of bipolar disorder because it increases endorphin levels.

But again, experts have yet to come to any conclusions about how LDN specifically affects bipolar disorder. Studies exploring the use of LDN for other conditions may provide insight into its potential benefits.

For example, people taking LDN for a chronic disease improvement report in co-occurring mental health conditions – including symptoms associated with bipolar disorder, such as:

Evidence of a small study from 2017 also supports the benefits of LDN for major depression. The study included 12 participants who experienced a recurrence of depression symptoms while taking antidepressants.

When the treatment group added 1mg of naltrexone to their drug regimen for 3 weeks, they noticed greater improvement in their flare symptoms than the placebo group.

So far, no evidence from large clinical trials supports the benefits of LDN for bipolar disorder – but to research suggests that LDN may hold promise for treating conditions that don’t always respond to conventional treatments, including:

Important

LDN is intended to support conventional therapies, not replace them. It is important to work with a medical or mental health professional to get treatment for any physical or mental health symptoms you are experiencing.

Like any other medicine, naltrexone can cause unwanted side effects. But LDN appears to pose less risk of side effects than regular-dose naltrexone.

Naltrexone Side Effects

Naltrexone is usually considered safe for people with bipolar disorder, but a case report from 2013 suggests that it can, in rare cases, trigger an episode of mania.

A regular dose of 50 mg of naltrexone can cause Side effects As:

As you may have noticed, these side effects are very similar to some symptoms of mania. This could make it difficult to determine if you are experiencing side effects or a mood swing.

If you notice any of these side effects, contact your doctor immediately. They can offer personalized advice on managing these symptoms and finding an alternative medication that better suits your needs.

LDN Side Effects

LDN tends to cause only mild and infrequent side effects. Headaches and intense dreams are among the most commonly reported effects.

Also, you may only notice these effects when you take a “higher” LDN dose of 4 to 5mg. Doses of 3mg or less usually involve minimal to no side effects.

The FDA has approved full-dose naltrexone only to treat SUD. LDN is not yet approved as a treatment for bipolar disorder due to lack of research on its potential benefits and side effects.

Therefore, a prescription for LDN is considered off-label use. Taking LDN is still legal with a prescription, but the lack of government approval can make it much harder to get a prescription or get coverage from your insurance company. Insurance plans often don’t cover medications prescribed for off-label use.

To try LDN, you will need your doctor to send a prescription to a preparation pharmacy. These places grind regular naltrexone tablets into small doses that you will need. As of 2018, each daily dose of LDN generally costs less than $1.

Regular dose naltrexone and LDN can help reduce symptoms of bipolar disorder, but they are not intended as stand-alone treatments.

In short, it is always important to work with a mental health professional for the treatment of bipolar disorder while taking naltrexone. Treatment may depend on your specific symptoms, but your healthcare team may recommend a combination of medication and therapy.

Learn more about finding affordable treatment for bipolar disorder.

Medication

Common medications for bipolar disorder include:

A doctor or psychiatrist can offer more information about medications for bipolar disorder.

Therapy

Types of therapy often used to help treat symptoms of bipolar disorder include:

  • Cognitive-behavioral therapy: This approach going to therapy can help you learn skills to deal with unnecessary thoughts, feelings, and behaviors.
  • Dialectical behavior therapy: This approach can help you practice mindfulness and emotional regulation skills.
  • Interpersonal and Social Rhythm Therapy: This approach, specifically designed to treat the symptoms of bipolar disorder, can reduce the frequency of mood swings by helping you create stable routines.
  • Family Centered Therapy: Family therapy can help you resolve conflicts and tensions in your relationships with loved ones.
  • Psychoeducation: Knowing more about bipolar disorder, including your specific triggers and symptoms, can help you better predict and manage mood swings.

Support groups, which allow you to connect with others who have gone through a similar experience, can also be helpful.

Check out our guide to the best support groups for bipolar disorder.

Although research into LDN for bipolar disorder is still in its early stages, some emerging evidence suggests it may help treat symptoms such as fatigue, sleep problems and feelings of depression.

If you want to try naltrexone, at any dose, a good first step is to ask your prescribing clinician about adding it to your treatment plan.


Emily Swaim is a freelance writer and writer specializing in psychology. She holds a BA in English from Kenyon College and an MA in Writing from California College of the Arts. In 2021, she received her Board of Editors in Life Sciences (BELS) certification. You can find more of his work on GoodTherapy, Verywell, Investopedia, Vox, and Insider. Find it on Twitter and LinkedIn.

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