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Re: Prozac Derealization But Improved OCD Exisessentialist

Posted by doxogenic boy on November 4, 2013, at 13:11:45

In reply to Re: Prozac Derealization But Improved OCD doxogenic boy, posted by Exisessentialist on November 2, 2013, at 13:40:20

> Is there anything that you're aware of that seems promising for derealization/depersonalization?

Here is what I found:
Behav Modif. 2013 Mar;37(2):226-42. doi: 10.1177/0145445512461651. Epub 2012 Nov 1.
A preliminary evaluation of repeated exposure for depersonalization and derealization.
Weiner E, McKay D.

Department of Psychology, Fordham University, Bronx, NY 10458, USA.

Dissociative symptoms including depersonalization and derealization are commonly experienced by individuals suffering from panic disorder or posttraumatic stress disorder (PTSD). Few studies have been published investigating the specific treatment of these symptoms in individuals diagnosed with panic disorder or PTSD, despite evidence that the subset of individuals with panic disorder who experience depersonalization and derealization report more panic attacks as well as greater panic severity and functional impairment. Furthermore, it has been shown that these symptoms can impede treatment and recovery in PTSD. Finally, recent research has shown that interoceptive exposure generally enhances the efficacy of treatment outcome for PTSD and PTSD with comorbid panic. This study investigated the use of a novel interoceptive exposure technique for treatment of depersonalization and derealization in individuals with high anxiety sensitivity and/or symptoms of PTSD. Results indicated significant reductions on six of seven items as well as total score on an outcome measure of depersonalization and derealization. Thus, this technique appears to hold promise for utilization as a form of interoceptive exposure in the treatment of these symptoms.
End quote.
Quote from the link above:
J Trauma Dissociation. 2012;13(3):311-29. doi: 10.1080/15299732.2011.606742.
Psychophysiological investigations in depersonalization disorder and effects of electrodermal biofeedback.
Schoenberg PL, Sierra M, David AS.

Depersonalization Research Unit, King's College London, London, England.

Previous studies investigating depersonalization disorder (DPD) report a lower baseline skin conductance level (SCL) and attenuated skin conductance response (SCR) to emotive stimuli. We hypothesized that increasing physiological arousal levels via electrodermal biofeedback may ameliorate disembodiment and emotional numbing symptomatology. Real-time versus sham biofeedback yielded a significant SCL increase after just 3 real-time biofeedback sessions in healthy volunteers. Subsequently, a randomized controlled biofeedback trial was administered with DPD patients. Findings were not replicated as SCL tended to fall, curiously more substantially in the real-time condition, concomitant with increased low- and high-frequency heart rate variability. To further investigate abnormal autonomic regulation in DPD, we compared basal autonomic activity between patients and healthy volunteers and found the former to be significantly more labile, indexed by greater nonspecific SCRs and higher resting SCLs. Rather than low sympathetic arousal, DPD might be better characterized by abnormal autonomic regulation affecting emotional and physiological responsivity.
End quote.

Have you tried rTMS?
(no abstract available) From the link above:
Brain Stimul. 2013 Aug 6. pii: S1935-861X(13)00228-3. doi: 10.1016/j.brs.2013.07.006. [Epub ahead of print]
Effects of Repetitive Transcranial Magnetic Stimulation (rTMS) on Specific Symptom Clusters in Depersonalization Disorder (DPD).
Christopeit M, Simeon D, Urban N, Gowatsky J, Lisanby SH, Mantovani A.

>Everything I've encountered stated that there's no conventional standard treatment but lamotrigine showed some promise in specific populations.

Yes, it says so in this article:

Excerpt from the link above:
Dear Editor,

Depersonalization disorder (DPD), a chronic condition characterized by a profound disruption of self-awareness, appears to be more common than previously thought and may possibly affect 1% of the general population.1,2 DPD usually presents with severe distress and functional disability. Because some of the symptoms may resemble those of psychotic and anxiety disorders (affect numbing, disembodiment, and social anxiety), DPD is often misdiagnosed.1,2 There is no established treatment for this disorder.2 We describe a case that illustrates the particularities of DPD and proposals for treatment.


As the patient did not respond to risperidone 2 mg/day, it was replaced with a selective serotonin reuptake inhibitor (SSRI), which led to anxiety improvement, but the specific symptoms of DPD grew worse. A subsequent change to venlafaxine 225 mg/day led to a significant mood improvement and a reduction in panic-like episodes; however, depersonalization and derealization remained unchanged.

Lamotrigine was then added at an initial dose of 25 mg/day, with a gradual increase to up to 200 mg/day. The patient had significant improvement in different aspects, such as affect, interpersonal contact and social interaction. The depersonalization symptoms gradually decreased, which made it possible for the patient to go back to work.
End quote.

>I'm still curious if the initial, severe start-up effects of adding the fluoxetine are indicative of its potential efficacy if I can hold-on until the side effects subside. A couple of big ifs...

Has it changed now?

Earlier TRD/anxiety
300 mg tianeptine, 6 X 50 mg successfully since Oct 2009
20 mcg liothyronine
40 mg escitalopram
100 mg trimipramine
50 mg agomelatine
600 mg quetiapine




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