I am planing to try rTMS for my depersonalisation. I have read all the publications in relation to DP and what people have written on the internet of their experiences.
I have the impression that temporoparietal junction (TPJ) that the early trails targeted might not be effective for most. Some har responded but most have not.
At the depersonalisation unit they have tried to repress the overactivity in the ventrolateral prefrontal cortex (VLPFC) with rTMS that should suppress emotions. 5. of 6 patients had a response, The TMS clinic I have corresponded with, do not take the structure in DP.
They inhibit the right dorsolateral prefrontal cortex (DLPFC) and adding a stimulation the left dorsolateral prefrontal cortex (DLPFC) and might add the TPJ if there is no response.It might take uptil 3.weeks with daily rTMS to try that. They have tried 9.patients and 4 have responded. Some of those who did´t responded had 5.sesssions of inhibition of the right dorsolateral prefrontal cortex (DLPFC). Their response rate would be higher if they included the ventrolateral prefrontal cortex (VLPFC) as it is like to be the most potent in its ability suppress emotions.
Money and time is a big factor in rTMS and why so few have tried and many only take a few session before they drop out. Many clinics only work with one area,- TPJ.
In relation to this I came across a publication from 2018 about right dorsolateral prefrontal cortex (DLPFC) and dorsolateral prefrontal cortex (DLPFC) ability to suppress emotions in relation to social rejection/social pain/ trauma. That fits with the theory behind depersonalisation that there is a switch in the brain that can shot it down in social stress where escape is not an option and cut of to the world and emotions. The switch might have two locations that can do that, -and not one.
I will contact another rTMS clinic in Europe that treats a number of states "off-label" but not DP. They might not know of it. There are some professors in psychiatry behind it. I will ask them if they are willing to try both locations. They might be interested in getting some experience with this disorder.
The publication I am taking about is the one and it says about these two structures of the brain;
Meta-analyses and systematic review of neuroimaging studies have indicated that both dorsolateral prefrontal cortex (DLPFC) and ventrolateral prefrontal cortex (VLPFC) are core regions involved in emotional regulation (Buhle et al., 2014; Kohn et al., 2014), especially in down-regulation of negative emotions (Zilverstand et al., 2017). In the context of social exclusion, two brain regions, the ventral anterior cingulate cortex (VACC) and VLPFC, have been implicated in emotional regulation of social pain (Riva and Eck, 2016). VACC response has not been consistently reported to social exclusion; with studies variously suggesting either decreased, unchanged (Somerville et al., 2006) or increased activity (Cristofori et al., 2013). In contrast, neuroimaging studies have provided convergent evidence that the VLPFC, especially the right VLPFC (rVLPFC), shows increased activity in response to social exclusion and plays a regulatory or inhibitory role, thus reducing the social pain (Eisenberger et al., 2003; Onoda et al., 2010). For instance, rVLPFC activity has been found to be negatively correlated with self-reported distress when participants are faced with social exclusion, suggesting that this region plays a key role in reducing social pain (Eisenberger et al., 2003; Masten et al., 2009).