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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by g_g_g_unit on July 3, 2013, at 11:19:39
I know this is quite a complex question -- and maybe something that couldn't be done justice to here -- but I was wondering if it was helpful or a hindrance to think of depersonalization as a separate entity/treatment target in the context of a primary anxiety disorder?
as I've mentioned here numerous times, I've suffered from OCD that's grown progressively more severe over the past 9 years. around the time of my first incident of Major Depression, I began to experience depersonalization phenomena (a sense of being unreal, pointless philosophical questions related to identity); previously, I had had similar feelings triggered by SSRI trials, but they seemed to persist following the onset of MDD.
since then, with the MDD, OCD and anxiety remaining untreated, the sense of detachment has persisted -- in fact, much of the past 6 years feels dream-like. however, what's become more problematic is that the depersonalization has become more and more phobic over the past 2 years, accompanied by agoraphobia, constant fears related to 'losing my mind', severe OC-related avoidance (it's complicated, but I feel like if I stop monitoring myself and pay attention to any other activities, I'll go crazy, which has come to restrict me from doing nearly anything).
what frustrates me is that I can recognize that there is a clear OCD component (the root disorder), but at the same time the depersonalization sensations feel valid (and didn't exist for the first 3-4 years of OCD). I set 'rules' about treatment -- this will probably sound very silly to most, but might register with those who suffer from OCD -- for example, I've come across one account in the archives of Effexor helping someone with DP and Ace's account of Nardil helping him, and so feel like I *have* to try those two drugs and that only they will 'cure' me. (for the record, I did try Nardil, early into treatment and pre-DP, but gave up after 12 weeks due to side-effects).
sometimes I feel like I'm looking for a drug that will make me feel real/alive again and wonder if that's fruitless, and if I should instead focus on the phobic/obsessional part. however, most anxiolytics to date (SSRIs, anticonvulsants etc.) have done little to treat the phobic anxiety and often worsen the feelings of dissociation.
I'm currently trying to save up for a Riluzole trial, but often feel plagued by the thought that it's the 'wrong' drug (i.e. because no one has specifically reported it helping DP) and that I'm being 'irresponsible'/doing myself a disservice. I hate this disorder.
Posted by rjlockhart37 on July 3, 2013, at 23:21:01
In reply to depersonalization etiology and anxiety/ocd, posted by g_g_g_unit on July 3, 2013, at 11:19:39
i've had dissociation but not as long as 6 years, it started in 04 after repeated failure at school, high doses of Wellbutrin 450mg, and litterly i went into a state of confusion that i wasnt sure what was reality and not....that was the worst time ever i had with that period, but the doc put me on klonopin and then zyprexa with adderall....so klonopin zyprexa and adderall all combined where somewhat effective....because there's two nueron slowing, antipsychotic, and adderall to stimulate the rest of the stuff that needed to be stimulated....
but im not recommending that, thats what worked for me....until my substance abuse started gettingin the way and had to learn to deal with out stimulants....vary hard.
i've had two out of reality states, one in 04-05, then in 09....when it turned into paranoia dissociatiom, i would see the same car following me, people staring at me in the store and writing down things, and they gave this evil look like they where gonna get me in prison, so i started playing along with it....and not to make alot of attention to myself...ignore the evil looks, and planned to stop if the same cars where following, and they where the same cars, im not blind, same model make, color.... it was all a plan to throw me in prison....yea that was a crazy time.....geodon and zyprexa at moderate heavy doses wiped it out, but it made it to where i didnt care if people where after me.OCD makes me crazy, im not really OCD, but amphetamine made me obsesses over things, pleasure motive stimulation....
have you thought about maybe pet scans? lithium or depakote may ease some of the ocd anxiety thoughts...but thats just my view:/
Posted by g_g_g_unit on July 4, 2013, at 9:29:16
In reply to Re: depersonalization etiology and anxiety/ocd, posted by rjlockhart37 on July 3, 2013, at 23:21:01
thanks for sharing, RJ .. it's pretty awful, isn't it? thankfully I've never been psychotic, but I'm not sure this is any less awful.
I have ADD too; unfortunately, it's so difficult to get treatment here that I generally try downplay or avoid disclosing the dissociative stuff, since I imagine that will just end up being blamed for any inattentive issues (despite being lifelong).
could a PET scan do much? I imagine I'd just be shrugged off as a hypochrondiac. never been on Lithium .. I was on Depakote, which helped anxiety but made me more depressed and caused a lot of spaciness and fatigue, even at low doses.
right now I'm interested in trying Riluzole for the OCD, though not sure how helpful it will be for the other symptoms.
Posted by sleepygirl2 on July 4, 2013, at 13:11:35
In reply to depersonalization etiology and anxiety/ocd, posted by g_g_g_unit on July 3, 2013, at 11:19:39
Has this ever responded to an antipsychotic?
Sorry you're going through this.
Posted by sleepygirl2 on July 4, 2013, at 13:17:49
In reply to depersonalization etiology and anxiety/ocd, posted by g_g_g_unit on July 3, 2013, at 11:19:39
What about lamictal?
I'm not in love with the drug, but I get episodes of detachment, like déjà vu times 10, but very brief. I take lamictal, and when I lowered the dose, I had another brief episode of it, followed by feeling depressed. I think the lamictal had been doing something. The problem did not persist, so I didn't go back up on the dose.
Posted by Beckett on July 4, 2013, at 19:11:31
In reply to Re: depersonalization etiology and anxiety/ocd » g_g_g_unit, posted by sleepygirl2 on July 4, 2013, at 13:17:49
Right now because of my own experiences with anxiety and depersonalization, I feel anxiety is such a critical component. I wish I could get mine tamed. Feeling like one is going crazy and having such high high anxiety takes it's toll on all levels. I feel anxiety drove me into my depressions.
I have no med suggestions. I just wanted to validate the awful place anxiety occupies.
Posted by g_g_g_unit on July 4, 2013, at 22:03:03
In reply to Re: depersonalization etiology and anxiety/ocd » g_g_g_unit, posted by sleepygirl2 on July 4, 2013, at 13:17:49
thanks sleepygirl -- most antipsychotics have caused movement issues/akathisia, even at low doses, so I've tended to avoid them.
Lamictal is actually one of the few medications that seems indicated for depersonalization; I haven't tried it, but Riluzole seems to work through a similar mechanism, so I've wondered if it might be of benefit.
Posted by sleepygirl2 on July 4, 2013, at 22:13:18
In reply to Re: depersonalization etiology and anxiety/ocd » sleepygirl2, posted by g_g_g_unit on July 4, 2013, at 22:03:03
Good luck :-)
Wishing you the best,
sleepy
Posted by g_g_g_unit on July 4, 2013, at 23:18:06
In reply to Re: depersonalization etiology and anxiety/ocd, posted by Beckett on July 4, 2013, at 19:11:31
> Right now because of my own experiences with anxiety and depersonalization, I feel anxiety is such a critical component. I wish I could get mine tamed. Feeling like one is going crazy and having such high high anxiety takes it's toll on all levels. I feel anxiety drove me into my depressions.
>
> I have no med suggestions. I just wanted to validate the awful place anxiety occupies.thanks Beckett, it can be so debilitating -- my heart goes out to you.
what meds are you taking currently?
Posted by rjlockhart37 on July 5, 2013, at 0:59:12
In reply to Re: depersonalization etiology and anxiety/ocd » rjlockhart37, posted by g_g_g_unit on July 4, 2013, at 9:29:16
a PET scan is ok-good kinda, I had a SPECT scan in 2009, don't get one....its silly, all it does is read the activty in the brain with colors.... but still there's not alot of tests that are superadvanced, there proably are in university study centers....but...somettimes the work to find to get treated for problems becomes extreme and draining, i've been looking for solutions with right now about my medication not working....its hard...
a PET scan may be a good choice....but still its expensive, and not guranteed to find the problem....ill try to keep searching some of the old research i did in 04 while it was happening....i know benzos are used for it, my doc gave me klonopin, but all the classes of medications they give are benzos, antidepressants, stimualnts, antipsychotics, mood stabliz/siezure medications/ all those are usally well used by doctor and finding a medication that is not one of these that could treat it....
rituzle? what do they use it for?
Posted by g_g_g_unit on July 5, 2013, at 6:28:12
In reply to Re: depersonalization etiology and anxiety/ocd, posted by rjlockhart37 on July 5, 2013, at 0:59:12
>
> rituzle? what do they use it for?
>
>
Rilutek or Riluzole..It's a glutamate antagonist that's only approved for ALS at this point -- it supposedly prolongs the lives of sufferers for several months.
However, it has shown efficacy in bipolar, depression, and most excitingly (from my standpoint anyway) severe, treatment-resistant OCD.
The only problem is it's ridiculously expensive.
Posted by SLS on July 5, 2013, at 8:36:43
In reply to depersonalization etiology and anxiety/ocd, posted by g_g_g_unit on July 3, 2013, at 11:19:39
My doctor feels that derealization occurs when anhedonia is combined with anxiety. I found this to be true for me.
- Scott
Posted by g_g_g_unit on July 5, 2013, at 12:41:54
In reply to Re: depersonalization etiology and anxiety/ocd » g_g_g_unit, posted by SLS on July 5, 2013, at 8:36:43
interesting. that would make sense, since SSRIs, anti-convulsants and the like might address the anxiety somewhat, but usually do little for the anhedonia and/or make it worse.
Posted by Beckett on July 5, 2013, at 13:35:09
In reply to depersonalization etiology and anxiety/ocd, posted by g_g_g_unit on July 3, 2013, at 11:19:39
Wiki says that Rilutek (in one small study) was shown to help depression and work as an anxiolytic for OCD and GAD. I suffer from the latter along with depression.
Scott's comment about anhedonia and anxiety fit my situation. The only thing that lifts the anhedonia temporarily is a little stimulant. It's so short-lived that some days I don't bother. Other than that I take lithium and Xanax.
Good luck to you. I wonder what my doc would say about Rilutek.
Posted by Beckett on July 8, 2013, at 20:07:18
In reply to depersonalization etiology and anxiety/ocd, posted by g_g_g_unit on July 3, 2013, at 11:19:39
Have you tried Namenda?
Posted by g_g_g_unit on July 9, 2013, at 7:47:34
In reply to Re: depersonalization etiology and anxiety/ocd, posted by Beckett on July 8, 2013, at 20:07:18
Yeah I have - it made my anxiety worse..
Posted by Beckett on July 10, 2013, at 21:43:53
In reply to Re: depersonalization etiology and anxiety/ocd » Beckett, posted by g_g_g_unit on July 9, 2013, at 7:47:34
Oh, sorry. I just asked my pdoc today about it. He's going to look into it.
My fingers are crossed for you.
Posted by g_g_g_unit on July 11, 2013, at 23:39:23
In reply to Re: depersonalization etiology and anxiety/ocd » g_g_g_unit, posted by Beckett on July 10, 2013, at 21:43:53
Thanks Beckett. I spoke to my GP yesterday -- he's generally pretty relaxed about stuff. I gave him some papers to look after and he said he'll get back to me in a week.
I spoke to Sanofi-Aventis and they said they can provide the drug for free in exceptional cases. It's such a pain because it's $30 with PBS assistance here and $700 off-label. I'm hoping a psychiatric case might qualify for special consideration.
This is the end of the thread.
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