Depersonalization-derealization disorder (DPRD) occurs when you persistently or repeatedly have the feeling that you're observing yourself from outside your body or you have a sense that things around you aren't real or both. Depersonalization and disassociation refer to a dreamlike state when a person feels disconnected from their surroundings.

 These types of sensations vary in severity and can result from a range of conditions, including post-traumatic stress disorder (PTSD) and the use of recreational drugs like methamphetamine, etc. DPRD is frequently a chronic disorder, affecting between 1 to 2.4% of the general population.  It was estimated in one survey that DPRD occurred in 80% of psychiatric inpatients and that 12% of them suffered from a severe form of this condition.

Depersonalization/derealization is categorized as one of the dissociative disorders.

• Dissociation is a general term that refers to a detachment from many things.

• Depersonalization is specifically a sense of detachment from oneself and one’s identity.

• Derealization is when things or people around seem unreal.

 

 

 

 

What causes depersonalization/derealization disorder?

 

• Being emotionally abused or neglected during childhood (a particularly common cause)

• Being physically abused

• Witnessing domestic violence

• Having a severely impaired or mentally ill parent or experienced any trauma or facing Post-traumatic stress disorder

• Episodes can be triggered by financial, or occupational stress; depression; anxiety; or the use of recreational drugs, particularly marijuana, ketamine, methamphetamine, or hallucinogens.

 

 

 

What are the symptoms of Depersonalization?

 

• changes in bodily senses

• a reduced inability to react emotionally

•  feeling like you’re outside your body, sometimes as if you’re looking down on yourself from above

• feeling detached from yourself, as if you have no actual self

• numbness in your mind or body, as if your senses are turned off

• feeling as if you can’t control what you do or say

•  a sense of disconnection from their own body

• the feeling that life is a dream, where everyone and everything seems unreal

• obsessive behavior, for example, repeatedly looking in a mirror to check that they are real

 

 

Diagnosis

Diagnosis of depersonalization/derealization disorder is clinical, based on the presence of the following criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5):

• Have regular episodes of depersonalization, derealization, or both

• Symptoms cause significant distress or significantly impair social or occupational lifestyle and functioning

• Patients know that their unreal and precarious experiences are not real (i.e, they have an intact sense of reality).

Psychologic tests and special structured interviews and questionnaires are helpful.

 

 

 

Medications used for DPRD:

 

There is no proper treatment plan for depersonalization/derealization disorder, but medications can reduce distressing symptoms like anxiety, depression, or post-traumatic stress disorder and even lead to full remission of the disorder.

Patients are apparently helped by selective serotonin reuptake inhibitors (SSRIs), lamotrigine, opioid antagonists like naltrexone and naloxone, anxiolytics, and stimulants. However, these drugs may work largely by targeting other mental disorders (e.g, anxiety, depression) that are often associated with or precipitated by depersonalization and derealization.

 

 

Lamotrigine

Lamotrigine is an anticonvulsant and a mood stabilizer.  Lamotrigine acts at the presynaptic membrane to reduce the release of glutamate (an excitatory neurotransmitter), and it has been shown to reverse depersonalization-related phenomena induced by the N-methyl-d-aspartate (NMDA) receptor antagonist ketamine in healthy individuals. 

 Lamotrigine has been reported in the treatment of DPRD because of its ability to impede glutamate release at the presynaptic membrane and to reduce the effects of ketamine on consciousness.

Neither lamotrigine alone nor serotonergic antidepressants alone have been shown to be reliably effective in treating depersonalization disorder, but the study suggests that when used in combination, these medications can produce a profound reduction in symptoms.

 

Conclusion:

Lamotrigine as a sole agent was not found to be effective in a previous randomized trial. However, evidence from open trials suggests it may be beneficial as an “add-on” medication with Selective serotonin reuptake inhibitors anti-depressants like Sertraline, Fluoxetine, etc.

 

 

Selective Serotonin Reuptake Inhibitors (SSRIs)

Most people with dissociative disorders have co-occurring conditions, and depression is one of the most common. Antidepressants, especially selective serotonin reuptake inhibitors (SSRIs), are frequently prescribed to treat comorbid depression. Popular SSRIs for dissociative disorders include:

• Sertraline (Zoloft)

• Fluoxetine (Prozac)

• Citalopram (Celexa)

The sense of detachment that accompanies depersonalization is often closely linked with a flat affect and blunted emotion, all of which can be improved with SSRIs.

 

 

Benzodiazepines

Sometimes called “benzos,” these are a class of psychoactive drugs. Benzodiazepines work with the GABA receptors in the brain, GABA is an inhibitory neurotransmitter.  These compounds are often prescribed for anxiety, panic disorders, and obsessive-compulsive disorders. It has been found that having high levels of anxiety sometimes results in depersonalization, and a person with DPD does experience bouts of anxiety. Because of this link, people taking benzos for DPD do sometimes experience some relief from it. Whether or not these compounds alleviate the underlying dissociation is still in question.

 

 

Clomipramine

Clomipramine comes under the brand name Anafranil, which is a tricyclic antidepressant. It works by restoring the balance of certain natural substances (serotonin, nor-epinephrine among others) in the brain.  It helps decrease persistent/unwanted thoughts (obsessions), and it helps reduce the urge to perform repeated tasks (compulsions such as hand-washing, counting, checking) that interfere with daily living. Clomipramine has also been used to treat depression, panic attacks, and ongoing pain.

 

 

 

Therapy

 

Many people find that therapy helps them to manage their symptoms. There are many different types of therapy, including counseling, Cognitive Behavioural Therapy (CBT), and Psychotherapy. In particular, CBT techniques have been shown to help people suffering from Depersonalisation and Derealisation Disorder.

 

 

 

References

Daphne Simeon, M. a. (2005). An Open Trial of Naltrexone in the Treatment of. Journal of Clinical Psychopharmacology, 267-270.

Eli Somer, T. A.-W. (2013, October 28). Evidence-based treatment for Depersonalisation-derealisation Disorder (DPRD). Retrieved from US National Library of Medicine: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4269982/

Eli Somer, T. A.-W. (2013). Evidence-based treatment for Depersonalization-derealization disorder (DPRD). BMC Psychology, 1-13.

H Belli, M. A. (2014, November 25). A Case of Depersonalization with Treatment-resistant Depression Successfully Treated with Sertraline-lamotrigine Combination. Retrieved from NCBI: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4655617/

Jones, Z. (2018, January 31). Lamotrigine in combination treatment for depersonalization disorder. Retrieved from Gender analysis: https://genderanalysis.net/depersonalization/lamotrigine-in-combination-treatment-for-depersonalization-disorder/

Julie P. Gentile, M. S. (2014, July). STRESS AND TRAUMA: Psychotherapy and Pharmacotherapy for Depersonalization/Derealization Disorder. Retrieved from NCBI: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4204471/

Raypole, C. (2019, February 1). Understanding Depersonalization and Derealization Disorder. Retrieved from HealthLine: https://www.healthline.com/health/depersonalization-disorder

Vara Saripalli, P. (2019, March 17). What are dissociation and depersonalization? Retrieved from Medical News Today: https://www.medicalnewstoday.com/articles/262888

Yuri L. Nuller, M. G. (2016). Effect of naloxone therapy on depersonalization: a pilot study. JOURNAL OF PSYCHOPHARMACOLOGY, 93-96.

 

 

 

 

 

 

 

 

 

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