This is my first time with Monument. My local psychiatrist moved away and I want to talk to somebody who really understands Naltrexone. 

I have been using Naltrexone for about two years to moderate my drinking. It has worked very well. It has cut the amount I drink by half, and also reduced the frequency and cravings. (I have not always used it as recommended, and sometimes even chosen not to take it, on "special occasions.") It has been instrumental in helping me come out of a deep depression--a depression that heavy drinking was definitely exacerbating. However, now out of deep depression, I'm back to my usual Bipolar II, which is characterized by non-destructive episodes of hypomania, alternating with mild depressive episodes. As I've now fully emerged from depression, the hypomanic episodes are becoming more pronounced, and the cycles between hypomania and depression much shorter. When I am in a hypomanic episode, the Naltrexone seems not to touch the alcohol. I want to -- and am able to -- drink all night, like back before I started Naltrexone. The alcohol is highly stimulating. And the hypomania makes me crave it all the more.

I realize there are many factors going on here, and that one answer might just to be to abstain from alcohol leading up to and during these episodes. But that's hard to anticipate, and hard to recognize in the moment. I'm also working with a psychologist on strategies for managing the bipolar patterns. But my psychiatrist left my network, so I want to connect with somebody who really understands how naltrexone works. Because I'm thinking that in the summertime--when the hypomanic episodes are most pronounced--I might want to take double the Naltrexone dosage. I'm also wondering whether my practice of takign Naltrexone daily, even when I am not drinking (which is 4 or 5 days a week) is somehow building up a resistance to the Naltrexone and making it less effective when I do drink. Looking forward to our consultation. Thanks in advance.