Mayer-Gross

Some mouths prior I got depersonalization I was in a crisis and I went to some therapy that included dream interpretations. So, I was very aware of my dreamlife. I could remember prior to the outset 2-3.dreams once a night. This changed after the outset to 2-3 once a month. 

Giulio Tononi have mentioned dissociative states in a book he wrote with the late noble prize winner, Gerald Edelman as a state of disintegrations of networks. A poorly integrated "default mode network" has also be mentioned as central in the dissociative subtype of PTSD. So, it is a failure to integrated emotions, sensory input. If the role of sleep and dreaming is integration and organizing such daily input it might be affected by the daily state one is in. I don't think depersonalization is a sleep disorder but the state has affect on sleep.In major depression it is also highly affected.  

I saw changes in frequencies of my dreams I could recall after depersonalization "came into mind",  I could recall them much less. When I by accident tried clonazepam 2.5 mg with duloxetine prior to sleeping I woke up the next morning I felt that I had, had a sleep much more diffrent and of better quality than I used to. I felt much more present and energetic. So, To me there is no doubt that the sleep architecture in depersonalization is affected. Research into depersonalization is very underfunded and a sleep study of the sleep architecture have never been made. Sleep is almost controlled by small areas in the midbrain so it is very old and essential areas that is affected. These areas have never been scanned in depersonalization as they are to small to detect in a 3.tesla scanner. A 7.tesla scanner might see differences. 

I would wish that this researcher into sleep and consciousness, Giulio Tononi could make a study of sleep in depersonalization. It likely have to be done in 15-20. patients to have a high validity. 

His biography; http://centerforslee...ple/tononi.html

His lab site; http://centerforslee....edu/index.html

There are no formal pharmacological treatment for depersonalization. You think there are. There are some indications that some might benefit form a combination of a anti-depressant with lamotrigine in a dose between 200-300.mg. It will take some time to reach such a dose. The alternative is more psychological approaches as it is a related to a anxiety condition and OCD like ruminations. This site have this approach.  

https://anxietynomor..._derealisation/

yes I also think like that as a first step what is the cause of our dpdr .. the question is where can we do fmri or dti?

This is absurd. I have never talked about scanning of individuals on this forum including myself. I have talked about more research with the use of scanners in population groups with depersonalization so there can be a more clear picture of the emotional regulation done by the brain and also to use more advanced rTMS to see if locations showing up as active plays a role. Can stimulation of these locations make a change in the state. 

Most scanners and those used at hospitals to rule out a neurological condition are typically 1.5 Tesla. These are to weak to psychiatric research and can not run as a DTI scanner or a fMRI. You have to go up to 3.tesla. These scanners also need high computer power to proces data and more recently artificial intelligence to analyse the data and find abnormalities. Their are very few 3.tesla scanners and the private market like private hospitals and they do not have the computer power to make analyses of data needed to study in psychiatry . You find these scanners in research institutions only. 

Then there is 7.tesla scanners. In the dissociative subtype of PTSD there are some strong indication that networks in the midbrain is involved. Everything in the midbrain is small and very powerful for the brain. A change in the midbrains response to stress will have huge effect on all the brain. But, because it is so small a 3.tesla scanner can not see it. So, to study the midbrain and networks from it with a 7.tesla scanner could be of relevance. 7.tesla scanners costs around 6-8.million dollars. There is one 7.tesla scanner in Danmark where I live. 10. in germany. 7.Tesla scanners are not approved for clinical use,- only for research. You have to be a part of a research project that have been approved to use it by a ethnical committee. So, 7.tesla scanners are not approved to the use in clinical patients.  The cost of a 10.min resting state fMRI in 3.tesla is 1000.dollars. The cost in a 7.tesla scanner is likely 4-5.times higher. A country like India have 3, 3.tesla scanners and no 7.tesla scanners. You likely only find 7.tesla scanners at research hospitals and universities in the top 100. in the world.

So, the idea that you can just get a 3.tesla scan of high quality and validity outside a research facility or you can get a doctor to refer you to it is pure fantasy. 

I write about because research into the disorder. Mapping of central locations and network that makes that state is central for making a intervention in it with more advanced brain stimulation. In reality can very serious research into depersonalization only done at very few places in the world .

You can as a private patients get a qEEG or a SPECT scan. These methods have not been used in psychiatry for many decades as they are very inaccurate and close to useless. In a recent evaluation of brain studies done in depersonalization qEEG, SPECT and PET scans was excluded because they are often to old and inaccurate. But, there a people who like these "horoscopes" of the brain made by a "astrology" doctor who want to earn some money by their pictures of colored "imbalances of the brain" 

Joe Perkins, who also have the youtube channel "DPD Diaries" have made this small video about how depersonalization feels. He is also related to the first depersonalization charity based in the UK called "Unreal". They might be interested in such information material about the disorder in their work. 

https://www.unrealuk.org

It sounds like depersonalization to me. You can try to test yourself on the Cambridge depersonalization scale here:

https://nanopdf.com/...-background_pdf

Yes. It could be secondary to a OCD state and atypicals might be of some benefits and so could high doses of SSRIs. But, there is also a strong OCD component in depersonalization its primary form. You could only test some medications and see if they are of some benefits to you. 

Look, it is you who have the idea that a psychiatrists knows anything about this disorder. I would say there is a 95% chance he dont. This is highly under and misdiagnosed. There is no exoteric knowlege that says "only for psychiatrists and doctors". Everything is open in medical databases with publications in medical journals. There is no publication at all saying that anti-psychotics have any benefits in depersonalization in its primary form. There is publication saying it is often misunderstood by psychiatrists as  symptoms of a psychotic state and a treatment for such is started up. I don't know if you have depersonalization in its primary form. I have seen many of this forum who have these symptoms secondary to another condition. Some with secondary depersonalization to another state might have benefits of anti-psychotics. 

One I know, had yesterday been in contact with the French researcher behind the rTMS trail at the right angular gyrus. The trail should according to the design from 2015 be a placebo controlled with a 100.patients. Last year they hoped to be finish around sept 2020 but they are still open for patients living in France. 

This is really depressing that a trail can take more than 6.years because they can not locate a 100.patients in the Paris area. Research into depersonalization was until recently done at two small units in London and New York that made some small examinations like brain scans and small trail,- clearly underfunded if one looks at the sizes of the patients used. Now, these are closed. 

So, the only research there is are some small studies done in other european countries. This is not enough if there shall be some hope of a treatment. 

The unawareness and that it is still highly undiagnosed seems to be the core problem in getting founding, recutting patients for doing more research into this condition. Deeply concerning. 

The former "Depersonalization research unit" wrote in a text about their experiences in the use of anti-psychotics drug; 

"However, if the clinician is not sufficiently alive to the fact that these are indeed similes or metaphors and that insight is preserved, a psychotic disorder may be erroneously diagnosed. We have seen a number of cases where patients with primary depersonalisation had been previously misdiagnosed with schizophrenia and started on antipsychotic medications, which had invariably worsened their symptoms"

https://www.cambridg...73145C016CC1F57

10.mg of olanzapine is a relatively high dose. 2.5 mg -5.mg might be better if one would try such an approach. 

One shall remember the depersonalization disorder is highly under diagnosed, misunderstood among medical professionals including the majority of psychtrists. The disorder is also found to be refractory to most pharmacological interventions. There are no formal treatment for depersonalization. 

If there was a drug or a natural remedy that helped a majority it would have been tried and replicated by many now. 

Here is a video done by Jonathan Downar with neuronavigation stimulation done with a deep coil at the dorsomedial prefrontal cortex in depression.

https://www.ncbi.nlm...les/PMC4692428/

This is also found overactive in depersonalization along with the anterior cingulate. In some scans in left dorsomedial prefrontal cortex should be larger/ most active. This location is also a OCD location in some. There is connections to the caudate nucleus from this location. So, it could be a location to explore. 

In dissociative subtype of PTSD a structure deep in the midbrain called the periaqueductal gray had shifted into a an area that is related to immobilization. They are working with a model where this shift is done by the right ventromedial prefrontal cortex that makes inhibition of anxiety and emotions and makes this shift in the Periaqueductal gray. To see in the midbrain for this and look for networks in there to other structures you need a fMRI at 7.tesla- not 3.tesla the is normally used. Everything is to small. In depersonalisation this shift in the Periaqueductal gray is likely also seen. But, the areas in the prefrontal cortex might not be the same as in the dissociative subtype. 

Some wrote to the French researchers at this time last years and they said that they were in a process of reviewing the data and would finish around sept 2020. As I wrote a research unit is typically restricted for people who are nationals of the authority who have approved the research. In reality they are often more restricted. Jonathan Downars research rTMS clinic in Toronto for depression is very open to people in that area but closed to the rest of Canada. When the "Depersonalization research unit" was active your could get a referral directly to them if you lived in the London area. If you lived in other areas in England you had to get the referral by a the area you lived under. They also had to pay the founding for your referral to the London area. So, it is very unlikely that any research done in one European country will accept nationals from another. 

As I wrote buprenorphine have had some slight reductions in some that also had problems with opioid addiction. Buprenorphine is a antagonist for the kappa receptor with high affinity. So, that is settle for me. It is also very unlikely that a selective kappa antagonist will be approved. They have failed in some trials and likely dropped. . Because you can have depersonalization secondary to many states doesn't mean that they are the same. Your can have depersonalization secondary to depression as many will respond with a typically antidepressent intervention. People with depersonalization in its primary form will not. Those who respond to rTMS at the left or right DLPFC typically have depression with secondary symptoms of depersonalization. 

A conventional rTMS coil can stimulate at the dept of 1.cm.That is the one approved for clinical use.  A coil for deeper stimulation was developed around 2015 and only used for research in Europe. It is not approved for clinical use yet. Magventure is with danish researchers trying to make another coil as part of the development. Jonathan Downar adresses in this text different locations in the prefrontal cortex and their stimulation. Most of them are highly dependent of a deep coil.https://dribrahimyil...emik-Makale.pdf

 You could likely test the diffrent locations with a Magventure D-b80 coil. Jonathan Downar have done that is depression since 2015. If there is a register in Germany with people who have been diagnosed with depersonalization disorder in a sufficient number it could likely be used. But, in the DTI scan they wrote it was difficult to find many and they wrote it was due to it was under diagnosed. It could also be related to it was both strutural brain scans and they likely wanted people who had been symptomatic for a long time as they are looking for small changes in sizes of the brain. Newly diagnosed would likely not make any data. . I think the average was 15.years.     

The German scans are both structural. A MRI and a DTI.

The DTI here; https://www.ncbi.nlm...les/PMC6158023/

The MRI here; https://pubmed.ncbi....h.gov/25285875/

The one from Japan I can not remember as it was posted by other. I remember it focused on dopamine. 

The French angular gyrus trial is unpublished but has been going on since 2015 -so likely difficulties to find a 100.subjects. The trial is here. https://clinicaltria...how/NCT02476435

I have tried two opiopate antagonists- naltrexone and nalmefeme without any effect. I do not think that is plays a central role. There are people here who have tried buprenorphine/subuxone that is highly antagonistic for the kappa receptor with some slight reduction. I do not think it makes the disorder.

In all medicine you have e replication crisis. Only 50% of studies can be replicated. I think that number might be higher in depersonalization because the studies are small, the trails are also very small. So, you might end up with using time on something that is useless and colored by your own hope. I have been there for years.

rTMS as it is used right now is very limited due to stimulation dept in the prefrontal cortex. You did not have coils that could go deeper that 1.cm and many areas in many with depression could not be tried and in depersonalization many areas are also too deep to try back then when these trial was done. A deep coil that is currently used in research can go to a dept of 2-2.2.cm so many areas can now be tested. I do not know if the current research programme can develop a coil that can go much deeper. Perhaps 3.cm. The new coil will be developed in Denmark while "Localite" in Germany will make software for network localization. Program here. It is still very early into development.   https://www.drcmr.dk...tant-depression

In research in depression this coil is used for deeper locations like the dorsomedial prefrontal cortex and the orbitofrontal cortex. It could alternatively be used. Both locations comes out as active in depersonalization and are also OCD locations.  

https://www.magventu...oils/cool-d-b80

If you could find a sufficient number of patients with "pure" depersonalization to do research that should not be a problem. The problem is this "stop-go" with one small trial here and there. You really need something that have good scannings capacity and in an area with people who have been correctly diagnosed with depersonalization in it primary form. It shall work continuously.A  research facility similar to what Jonathan Downar have for depression research would be ideal. A combination of fMRI and advanced rTMS to isolate locations and networks in the disorder.  http://rtmslab.com

I Denmark where I live there is a research programme between two companies from Danmark and Germany and some research institutions to make more advanced rTMS equipment. The ambition is to develop equipment that can treat refractory depression but also other conditions that have few treatment options today. A professor in psychiatry who is a part of the programme said that the ambition is to develop more indivualistic treatments for patients and use fMRI scans in the individual patient to find locations for rTMS interventions. This programme that should run until 2023 and I expect them to start some testning in Denmark and Germany around 2022 of their hardware. I could likely try to contact this professor I have spoken to years back to see if they would give depersonalization a try to test the new equipment. It would likely involve several rMRI scans do in a process. This development could if it succeeds could also open up for many individual case studies of patients with depersonalization in countries that adopt this equipment.