Can Low-Dose Naltrexone Help OCD? What the Evidence Says

If you live with OCD and have read about low-dose naltrexone (LDN), it is fair to wonder whether it could help you. Here is the short answer. As of September 2026, we could not find a single published study of low-dose naltrexone for OCD. The closest research used standard-dose naltrexone, which is many times stronger. Those studies are tiny, and they disagree. In the most careful one, OCD did not improve, and anxiety and low mood got worse on the drug.2

LDN is not a recommended treatment for OCD. The treatments with strong evidence are a therapy called exposure and response prevention (ERP) and SSRI medicines.9 This guide covers what has been studied, what has not, and what helps.

Key takeaways

• No published study has tested low-dose naltrexone for OCD. A 2026 review of LDN research does not mention OCD at all.1
• A few small studies tested standard-dose naltrexone, and their results conflict. The most careful one found no OCD benefit and more anxiety and low mood.2
• A theory about how LDN might work is a reason to do research. It is not a reason to start treatment.
• ERP therapy and SSRI medicines have the strongest evidence for OCD, and there are clear next steps when they are not enough.9

Why do people ask about LDN for OCD?

LDN has a loyal following among people with chronic pain, fatigue, and autoimmune illness. In those communities it is often described as a gentle medicine that calms inflammation. Parents in PANS and PANDAS groups hear about it too. From there it is a short step to a fair question. If inflammation plays a part in some OCD, could LDN calm OCD?

OCD is exhausting, and first treatments do not always work. Wanting something gentle and new makes sense. The honest answer is that nobody has tested the question.

What is LDN?

Naltrexone is an FDA-approved medicine for alcohol and opioid use disorders. At its standard dose, it blocks the body’s opioid receptors around the clock. Low-dose naltrexone uses a small fraction of that dose, taken once a day.

A 2026 review looked at LDN research across all conditions. It concluded that current evidence “does not support routine clinical use.”1 Our full guide to LDN in psychiatry explains how it may work and where the research is strongest.

What has been studied?

Every study below used standard-dose naltrexone or a related drug. None used LDN.

A small, careful trial (2008). Ten adults had OCD that had not responded to an SSRI or clomipramine. Each took naltrexone for five weeks and a placebo for five weeks, in random order, without knowing which was which. OCD scores did not improve on naltrexone. Ratings of anxiety, depression, and overall illness were significantly worse on naltrexone than on placebo.2

An open-label study (2007). Twenty-three adults with OCD started naltrexone for two months. Sixteen finished, and their OCD scores fell. There was no placebo group, so there is no way to know how much of the change came from the drug. Most participants also had a bipolar-spectrum condition. The authors called their result tentative.3

A small three-group trial (2008). Thirty adults took naltrexone, fluoxetine, or a placebo for eight weeks. The report says both medicines lowered OCD scores by about the same amount, and both did better than placebo.4 This trial had only 30 people across three groups. It appeared in a small regional journal, and no one has repeated it.

Two early experiments with naloxone. Naloxone is a short-acting opioid blocker given by vein. The authors of the 2008 trial summed up this earlier work. In one report, two patients had worse obsessive doubt after a dose. In a placebo-controlled study of 13 adults, there was no overall change. Three of the 13 had a clear rise in symptoms on naloxone.2

So the picture is a handful of tiny studies that point in different directions, and none used a low dose. When small studies disagree, the honest reading is “we do not know.” There is one caution. In the best-designed trial, people felt worse.

One finding that points the other way

One more study cuts against the idea that blocking opioid receptors should help OCD. In 2005, researchers gave 23 adults with hard-to-treat OCD three treatments in random two-week blocks. The treatments were a once-weekly opioid medicine (morphine), a once-weekly anti-anxiety medicine, and a placebo. Seven people responded to the opioid. No one responded to the placebo.5

This is not a treatment, and no one should seek it out. Opioids carry serious risks, including addiction and overdose, and no guideline recommends them for OCD. The study matters for one reason. If turning the opioid system up eased symptoms for some people, then turning it down is not an obvious fix.

Does a low dose work differently?

Supporters of LDN point to two theories. First, a brief block of opioid receptors may lead the body to make more of its own endorphins afterward. Second, LDN may quiet overactive immune cells in the brain called microglia. Our main LDN guide explains both.

These ideas come from lab work and pain research. Neither has been tested in people with OCD. A theory is where research starts. It is not where treatment starts.

Are skin picking and hair pulling different?

Yes. These conditions are related to OCD, but they are not the same, and the research is separate.

For LDN, the published evidence is one case report. A 51-year-old woman took LDN for fibromyalgia. Her skin picking eased, got worse when she stopped the medicine, and eased again when she restarted.6 One case cannot show cause.

For hair pulling, a placebo-controlled trial tested standard-dose naltrexone in 51 people for eight weeks. Naltrexone did no better than placebo at reducing pulling.7

The best-studied treatment for both conditions is a behavioral therapy called habit reversal training. A 2019 review found ten randomized trials. All showed some drop in symptoms, though the authors said the studies were too small and uneven to draw firm conclusions.8

What about PANS and PANDAS?

Parents often arrive here after a sudden change in their child. As of September 2026, we could not find a published trial of LDN for PANS or PANDAS. These conditions need a pediatric team that knows them well. Our main LDN guide has a short section on this topic.

What works for OCD?

OCD is treatable, and the first steps are well mapped.

• ERP therapy. Exposure and response prevention is the first-choice therapy for adults, teens, and children.9 You face a feared thought or situation in small steps and practice not doing the ritual. Our essay on how ERP works walks through it.
• SSRI medicines. These are the first-choice medicines for OCD.9 Clomipramine is another effective option, often used when SSRIs have not been enough.9
• Both together. Combining ERP with medicine is common.9
• Next steps. When first treatments fall short, options include adding a second medicine and brain stimulation such as TMS for OCD.9

If you have tried one SSRI or a few therapy sessions and still struggle, you have not run out of options. Most people have several well-studied steps left.

What if I already take LDN and have OCD?

Some people take LDN for pain or fatigue and also have OCD. If that is you:

• Do not stop or start any medicine on your own. Talk with the clinician who prescribes it.
• Tell your prescriber if your anxiety or mood gets worse. In the 2008 trial, both got worse on standard-dose naltrexone.2
• Never combine LDN with opioid medicines. The safety section of our main LDN guide explains why, and what to tell your surgeon or dentist.

If you ever have thoughts of ending your life, or you cannot keep yourself safe, use the crisis numbers at the end of this page right away.

Bottom line

No one has studied low-dose naltrexone for OCD. The small studies of standard-dose naltrexone conflict, and in the most careful one people felt worse. LDN is not a recommended OCD treatment. ERP and SSRI medicines are, and there are good next steps after them. If OCD is still running your day, the most useful move is a conversation about those options.

This article is for education, not personal medical advice. Do not start, stop, or change a medication without the clinician who manages it. Sources were checked on September 20, 2026.

Related reading on NP FADY

• Low-Dose Naltrexone (LDN) in Psychiatry: A Comprehensive Guide
• No, You’re Not “a Little OCD”: What OCD Actually Is (Part 1)
• ERP: The Treatment That Feels Backwards but Works (Part 4)
• TMS for OCD: What It Targets, What the Evidence Shows, and What to Ask

References

1. Gouda AHK, Aitcheson NEC, Steadman KJ. “Low-Dose Naltrexone: What is the Evidence? A Narrative Review.” Advances in Therapy. 2026;43(7):2852–2870. DOI: 10.1007/s12325-026-03612-5. Springer.

2. Amiaz R, Fostick L, Gershon A, Zohar J. “Naltrexone augmentation in OCD: a double-blind placebo-controlled cross-over study.” European Neuropsychopharmacology. 2008;18(6):455–461. Ten adults; the introduction summarizes the earlier naloxone reports. Tel Aviv University.

3. Hamidi A, Jahanguiri B, Nasr Esfahani M, Dadfar M. “Naltrexone in Obsessive-Compulsive Disorder: an Open-Label Trial.” Iranian Journal of Psychiatry and Behavioral Sciences. 2007;1(1):16–21. 23 enrolled, 16 completed; no placebo group. Brieflands.

4. Masoudzadeh A. “The comparison therapeutic effect of naltrexone and fluoxetine on obsessive-compulsive disorder: a clinical trial study.” Journal of Gorgan University of Medical Sciences. 2008;9(4):18–24. 30 adults in three groups; 8 weeks. DOAJ.

5. Koran LM, Bullock KD, Aboujaoude E, Gamel N, Franz B, Elliott M. “Double-Blind Treatment With Oral Morphine in Treatment-Resistant Obsessive-Compulsive Disorder.” Journal of Clinical Psychiatry. 2005;66(3):353–359. 23 adults; 7 responders on morphine, none on placebo. JCP.

6. Varghese K, Yan X, Cao F. “Low-Dose Naltrexone for Excoriation Disorder.” Cureus. 2024;16(3):e55336. DOI: 10.7759/cureus.55336. Single case report. Cureus.

7. Grant JE, Odlaug BL, Schreiber LRN, Kim SW. “The opiate antagonist, naltrexone, in the treatment of trichotillomania: results of a double-blind, placebo-controlled study.” Journal of Clinical Psychopharmacology. 2014;34(1):134–138. 51 participants; 8 weeks. University of Minnesota.

8. Lee MT, Mpavaenda DN, Fineberg NA. “Habit Reversal Therapy in Obsessive Compulsive Related Disorders: A Systematic Review of the Evidence and CONSORT Evaluation of Randomized Controlled Trials.” Frontiers in Behavioral Neuroscience. 2019;13:79. DOI: 10.3389/fnbeh.2019.00079. Frontiers.

9. International OCD Foundation. “OCD Treatment Guide.” Accessed September 20, 2026. ERP and SSRIs as first-line treatments; clomipramine, augmentation, and TMS as further options. IOCDF.

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