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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 Prefect on November 6, 2016, at 19:02:53
My anxiety most often causes me to zonk out and disconnect, which I HATE. During these times I have trouble concentrating, thinking, feeling, or even following a conversation. It's like my brain shuts off parts to avoid panic.
I prefer the fight-or-flight reaction, because it eventually relieves anxiety by working through your system, but I rarely have this luxury. I just check out.
Most anxiety meds are designed to reduce the right-or-flight reaction. I would like something that targets the mechanism that causes derealization.
Thanks,
Posted by rjlockhart37 on November 6, 2016, at 23:04:10
In reply to Best Medication for Derealizing, posted by Prefect on November 6, 2016, at 19:02:53
lithium mixed with a benzo could treat this....also propranolol will block the fight or flight response by blocking noradrenaline
my own view: sometimes a low dose stimulant with a benzo can relieve the de-realization - stimulant/barbiturate combinations back in the older generation was to help depression with anxiety......obviously they took all stimulant/barbiturate medications off the market,
I've had de-realization and dissociation for 2 years, it first happened in 2004, I was just driving around and everything seemed like a dream - it was really scary and I felt disconnected from reality - but also I was on Wellbutrin and for reason it made it worse - then in 2008-09 I had it again, disconnecting and feeling I was the only person on the planet - and the reason I'm saying a low dose stimulant with a benzo is it helped some with it during that period, I was on Dexedrine and Xanax and I took them together, it stopped depression and anxiety and made me feel back down to earth
talk with your doctor about your symptoms, see if you can find a good treatment to work with
r
Posted by rjlockhart37 on November 6, 2016, at 23:12:17
In reply to Re: Best Medication for Derealizing, posted by rjlockhart37 on November 6, 2016, at 23:04:10
but propranolol would be a good option, stimulant/benzo combination is not really a good option with doctors, and can be seen as improper method to treat it - I apologize because it is not proven to work and a lot of doctors would see this as an unethical method
look at different beta blockers, and maybe a low dose anti-psychosis medication.....
Posted by SLS on November 7, 2016, at 7:30:36
In reply to Best Medication for Derealizing, posted by Prefect on November 6, 2016, at 19:02:53
Hi Prefect.
> My anxiety most often causes me to zonk out and disconnect, which I HATE. During these times I have trouble concentrating, thinking, feeling, or even following a conversation. It's like my brain shuts off parts to avoid panic.
>
> I prefer the fight-or-flight reaction, because it eventually relieves anxiety by working through your system, but I rarely have this luxury. I just check out.
>
> Most anxiety meds are designed to reduce the right-or-flight reaction. I would like something that targets the mechanism that causes derealization.
>
> Thanks,It is sometimes hard to diagnose a dissociative state like derealization.
1. Did you ever experience a traumatic event or chronic trauma during childhood?
2. How old are you now?
3. When did these states appear relative to the onset of depression and / or anxiety?
4. Have you had psychotherapy?
Severe anxiety or depression can themselves precipitate dissociative states. You might be right about your brain / mind wanting to shut-down as a defense mechanism against anxiety. My doctor likes to frame derealization as being a result of a combination of ahnedonia and anxiety. My personal experience with chronic derealization is that an effective antidepressant minimized it. I was also able to process psychological issues easier in the absence of depression. In my case, the depression was the driver of the anxiety. In other people, the anxiety drives the depression. Finding a medication treatment that addresses both can come in the form of certain antidepressants. Paxil and Effexor are the first two that come to mind. Nortriptyline might help if depression is the underlying precipitator of the anxiety. Some antipsychotics can be used if nothing else is currently helping. Low dosages of Seroquel seem to be effective for anxiety. For me, Nardil worked well for awhile. When I relapsed into depression, the anxiety and depersonalization emerged again.
RJs suggestions are interesting and worth exploring. Amphetamines can produce what are considered to be paradoxical effects - even being effective to reduce mania in bipolar disorder and hyperactivity in ADHD. Taking propranalol right before exposure to an axiety-inducing event might be an option until you find a more effective and sustainable treatment.
- Scott
Posted by Christ_empowered on November 7, 2016, at 11:41:25
In reply to Best Medication for Derealizing, posted by Prefect on November 6, 2016, at 19:02:53
this is kinda random, but I vaguely remember a poster on here who was prescribed Stelazine for derealization. I mean...its a high(er) potency, old school antipsychotic...low doses were (are?) used for some forms of anxiety.
Do you have a primary diagnosis? I had intense dissociative weirdness with my...well, they're calling it Bipolar...and now that the primary problem is adequately dealt with (Rx pills+Orthomolecular, in my case), the dissociative problems don't pop up.
Posted by baseball55 on November 7, 2016, at 18:21:24
In reply to Re: Best Medication for Derealizing, posted by Christ_empowered on November 7, 2016, at 11:41:25
I was having severe problems with derealization and risperdone stopped it right away. Of course, you don't want to stay on that for a long time. I have always found, and I'm sure I am a minority here, that bad anxiety reactions that overwhelm my mind and body seem to really get knocked out permanently once the cycle is interrupted. Xanax and risperone both worked that way for me.
Posted by Prefect on November 7, 2016, at 19:34:17
In reply to Re: Best Medication for Derealizing » Prefect, posted by SLS on November 7, 2016, at 7:30:36
Interesting questions Scott, but I have an odd history that's baffled me for 20 years. I'm 47 and have never had an event I consider traumatic enough to cause this condition. This condition itself is the most traumatic thing that's ever happened to me.
1997-I was 27 I came down with a mysterious illness. The only thing blood tests showed was VERY elevated liver enzymes, but no jaundice, and tested negative for all hepatitis viruses. It just felt like a bad hangover, but in one week developed into balance problems, dizziness, mental fogginess, memory problems, week high pulse, night sweats, bad sleep, and strange GI symptoms. Also had my first panic attacks that week. I did not have a mental illness until that week. Liver enzymes settled and stayed down after a few months. The mental problems have stayed. I have agoraphobia, panic disorder, and just recently began 'zonking out' from anxiety and realized in 1997 half the time I thought I had brain fogged I was in fact derealizing from severe anxiety but due to my lack of experience with anxiety I didn't know what it was.
Internist at the time diagnosed me with Chronic Fatigue Syndrome and put me on 25 mg Luvox. Over the years I've begun doubting this diagnosis, since I have immense exercise tolerance and hardly any body fatigue. My HEAD though, and my sleep, have never felt the same as they did before that week. I've since got a career and a marriage under my belt, the latter of which recently broke down mainly due to my emotional problems and irritability I've had since 1997. Over the last 2 decades I've upped my doze to 100 mg to help with this, but most of it I've been handling with exercise and self-implemented exposure therapy.
I am convinced my mental state is due to an organic event but haven't yet got to the bottom of what it is. Lately I had a sleep study done to see if Sleep Apnea could have been causing all this, though I have no idea how they'll diagnose me since I hardly got any real sleep in that stupid lab. They'll tell me the results in a couple of weeks.
Thanks for reading this long story!
Posted by SLS on November 7, 2016, at 19:48:57
In reply to Re: Best Medication for Derealizing, posted by baseball55 on November 7, 2016, at 18:21:24
> I was having severe problems with derealization and risperdone stopped it right away. Of course, you don't want to stay on that for a long time. I have always found, and I'm sure I am a minority here, that bad anxiety reactions that overwhelm my mind and body seem to really get knocked out permanently once the cycle is interrupted. Xanax and risperone both worked that way for me.
How long does it take for risperidone to work for you? It is interesting that you describe a cycle that can be interrupted.
- Scott
Posted by baseball55 on November 8, 2016, at 19:30:04
In reply to Re: Best Medication for Derealizing » baseball55, posted by SLS on November 7, 2016, at 19:48:57
> > I was having severe problems with derealization and risperdone stopped it right away. Of course, you don't want to stay on that for a long time. I have always found, and I'm sure I am a minority here, that bad anxiety reactions that overwhelm my mind and body seem to really get knocked out permanently once the cycle is interrupted. Xanax and risperone both worked that way for me.
>
> How long does it take for risperidone to work for you? It is interesting that you describe a cycle that can be interrupted.
Risperidone worked within hours for derealization.
Posted by Prefect on November 12, 2016, at 10:44:57
In reply to Re: Best Medication for Derealizing » Prefect, posted by SLS on November 7, 2016, at 7:30:36
Scott, you mentioned an SNRI in your response. Do norepinepherine reuptake inhibitors not make anxiety worse? I've been curious about this class of drug lately, because once in a while I feel like I have low circulating cortisol and get brain fog. thx
Posted by porkpiehat on November 13, 2016, at 11:45:06
In reply to Re: Best Medication for Derealizing, posted by baseball55 on November 8, 2016, at 19:30:04
How did you all realize you were having derealization/dissociative issues?
I always just thought my anxiety and depression were getting in the way of me thinking clearly. I mean I guess that's what it is, but...
I figured it out at 44, on my own without Dr's input, after having them at night and having AAP's made me worse. FWIW I'm finding some mix of SSRI and a stimulant keeps most of it at bay, although I'm having issues with impulsivity and drinking now.
Posted by baseball55 on November 13, 2016, at 20:00:48
In reply to Re: Best Medication for Derealizing, posted by porkpiehat on November 13, 2016, at 11:45:06
The first few times it happened, I didn't realize there was such a feeling and a term for it. I just felt that things around me weren't real. It was frightening and made me panicky. It's only later that I heard the term and description and realized - oh, that's what that is.
My therapist is really into grounding exercises to deal with anxiety and derealization. Focus on your breath, feel your feet on the floor, sort of thing. Sort of like meditation.
> How did you all realize you were having derealization/dissociative issues?
>
> I always just thought my anxiety and depression were getting in the way of me thinking clearly. I mean I guess that's what it is, but...
>
> I figured it out at 44, on my own without Dr's input, after having them at night and having AAP's made me worse. FWIW I'm finding some mix of SSRI and a stimulant keeps most of it at bay, although I'm having issues with impulsivity and drinking now.
Posted by Lamdage22 on November 14, 2016, at 11:47:40
In reply to Re: Best Medication for Derealizing, posted by baseball55 on November 13, 2016, at 20:00:48
what is the difference derealization vs. psychosis? Is derealization and pre-psychotic the same or can it be the same?
Posted by Horse on November 16, 2016, at 10:22:43
In reply to Best Medication for Derealizing, posted by Prefect on November 6, 2016, at 19:02:53
I don't know my chem, and I can't address the nature of your symptoms, but Clonidine or Guanfacine? Both are available for extended release. Chronic anxiety is the pits.
Posted by baseball55 on November 16, 2016, at 20:14:04
In reply to Re: Best Medication for Derealizing, posted by Lamdage22 on November 14, 2016, at 11:47:40
> what is the difference derealization vs. psychosis? Is derealization and pre-psychotic the same or can it be the same?
Derealization doesn't involve delusions or hallucinations. It's just a profound sense that the world around is not real or that you are not real or part of the world (the latter is called depersonalization). I think in the DSM, it's considered an anxiety disorder and I have found it very much like an extended panic attack.
Posted by Lamdage22 on November 17, 2016, at 4:46:49
In reply to Re: Best Medication for Derealizing, posted by baseball55 on November 16, 2016, at 20:14:04
my roomate keeps saying he dissociates. No idea what he means
Posted by baseball55 on November 17, 2016, at 18:14:07
In reply to Re: Best Medication for Derealizing, posted by Lamdage22 on November 17, 2016, at 4:46:49
> my roomate keeps saying he dissociates. No idea what he means
I've never fully understood what dissociation means either. People say they lose time and compare it to highway hypnosis.
Dissociative Identity Disorder has, I think, been taken out of the DSM. It referred to people losing time because they were split into different personalities which were not integrated in one sense of self - also known as multiple personality disorder. Most mental health practitioners now believe that this disorder doesn't exist and that the few publicized cases (like Sybil) were essentially made up by the treating doctors.
Posted by baseball55 on November 18, 2016, at 18:52:27
In reply to Re: Best Medication for Derealizing » Lamdage22, posted by baseball55 on November 17, 2016, at 18:14:07
One other thing about dissociation. I think people do dissociate in the sense that they retreat in a numb state when they have been victims of abuse. I did when I was young. My boyfriend at the time said that one day I would be animated and talking, then I would clam up and be unreachable for days at a time. I do not remember this. So I think that was dissociation.
On the other hand, I have been in groups where women started crying and saying they were dissociating which annoyed me because the main feature of dissociation is that you don't know when ou're dissociating.
This is the end of the thread.
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