Psychodynamic approaches based on self-constancy—cohesiveness and stability of self-representation—may be helpful, especially in patients with acute symptoms.24 Cognitive-behavioral therapy may be effective and could be divided into 2 phases:
Table 3
Depersonalization comorbidity: Common disorders
| Disorder | Percentage of depersonalization patients reporting comorbidity |
|---|---|
| Anxiety | 45% |
| Major depressive disorder | 41% |
| Panic disorder | 22% |
| Agoraphobia | 11% |
| Source: Reference 8 | |
- nonspecific interventions such as activity scheduling, graded exposure to avoidance behaviors, and negative automatic thought charts
- techniques to facilitate controlled re-experiencing of emotions and refocusing of attention away from the self and the depersonalization experience.25
Measures such as relaxation techniques, breathing exercises, yoga, tai chi, and meditation also might help decrease anxiety.
OUTCOME: Why did it work?
Ms. A responded partially to the diazepam-clomipramine combination but experienced a full response only after we added aripiprazole. We are not certain whether her response was caused by aripiprazole, a delayed action of clomipramine, or a spontaneous remission. Aripiprazole, 2.5 mg/d, was the first medication we added when Ms. A presented to our clinic and she had reported a partial response to the drug. Aripiprazole was also the last medication added before she experienced response, which lasted for at least 5 months, after which Ms. A was lost to follow-up.
The authors’ observations
We believe that aripiprazole might rebalance serotonin/dopamine neurotransmission for some patients with depersonalization disorder. We theorize that aripiprazole’s blockade of serotonin 2A receptors may enhance dopamine release in certain areas of the brain, possibly improving cognitive and affective symptoms. Depersonalization may be a symptom of worsening psychiatric illness and justifies the use of intensive pharmacologic and psychological therapy.
Related resource
- Simeon D. Feeling unreal: Depersonalization disorder and loss of self. New York, NY: Oxford University Press; 2006.
Drug brand names
- Amantadine • Symmetrel
- Aripiprazole • Abilify
- Bupropion • Wellbutrin
- Buspirone • BuSpar
- Citalopram • Celexa
- Clomipramine • Anafranil
- Clonazepam • Klonopin
- Diazepam • Valium
- Escitalopram • Lexapro
- Fluoxetine • Prozac
- Fluvoxamine • Luvox
- Ketamine • Ketalar
- Naltrexone • ReVia
- Olanzapine • Zyprexa
- Paroxetine • Paxil
- Quetiapine • Seroquel
- Sertraline • Zoloft
- Trazodone • Desyrel
- Venlafaxine • Effexor
Disclosure
The authors report no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.