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Depersonalization disorder

Question. What drugs have you found to be most effective in treating depersonalization disorder? I have tried SSRIs, antidepressants and other medications as well. I have had this for three years straight as a result of stress, anxiety and panic disorder.

Answer. Depersonalization disorder, in brief, involves the persistent or recurrent experience of feeling detached from, and as if one is an outside observer of, one’s mental processes or body. Individuals with depersonalization disorder (DD) often report feeling as if in a waking dream or a movie and may also experience derealization (the sense that the external world is unreal or strange). DD is not a psychotic condition, though individuals with depersonalization disorder often worry about this. Unfortunately, there is very little rigorously designed research on the pharmacologic treatment of depersonalization disorder.

Depersonalization disorder

However, I would first like to suggest that the diagnosis of depersonalization disorder is in serious doubt, if you experience depersonalization only in the context of actual panic attacks or panic disorder (PD), since depersonalization/derealization is one feature of PD. Indeed, DD by itself is quite rare. Usually, panic disorder is also accompanied by other bodily sensations, such as rapid heart rate, dizziness, sweating, tingling, choking sensation, as well as a fear of going crazy or having a heart attack.

If you experience depersonalization solely in the context of such attacks, then it is the panic disorder that needs treatment. Since you have tried SSRIs and antidepressants, it may be time to consider alternative medications and approaches for PD; e.g., trial on an MAOI (a special type of antidepressant), Serzone or Depakote. Klonopin may also be helpful for panic disorder. Cognitive-behavioral therapy (CBT) is also very helpful for panic disorder, if done by someone with special training in CBT.

If, on the other hand, your panic disorder has been adequately treated and you still have episodes of depersonalization/derealization, then it may be useful to consider adjunctive approaches or medications. First, I would make sure that neurologic conditions that may mimic depersonalization disorder have been ruled out; e.g., temporal lobe seizures or atypical forms of migraine headache. Relaxation techniques (which by themselves are not very useful for Panic Disorder) may help, if the DD is generally related to stress or anxiety. While there are no proven medications for the treatment of depersonalization disorder, there have been case reports of benefit with the use of antianxiety agents (such as clonazepam); stimulants (such as methylphenidate); and MAOIs (such as phenelzine). Also, buspirone might be worth trying since it does not pose long-term risks of dependence, unlike benzodiazepine-type drugs (Valium, Xanax, Klonopin, etc.).

 

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