Why is this thread even a debate? There have been several with heroin addiction and depersonalisation disorder who has been on suboxone/buprenophine with a very low respons as 20 -30% reduction in symptoms. It has a high antagonistic effect on the kappa opioid receptor . It is the kappa opioid system that can shot drown for emotions and the reward system to stress, anxiety and addiction other parts of the opioid system cannot do that so they are excluded. Drugs like naltrexone, nalmefeme and naloxone have either a very short half-life or a very low affinity for the kappa-opioid receptor. The trails done with these drugs where small, not repeated and 20-15.years old. They have never been replicated in larger trails but many on this forum has tried them with no to limited effect effect. Those who have tried drugs like suboxone has had a limited effect. Here is one that had a 20-30% reduction in symptoms with suboxone;
"I wouldn't do it if I were you. I have been on it long term. It's a serious drug. It's what they give heroin addicts to help during the withdrawal process. Most people don't stay on it long term. If you do stay on it long term and want to quit at some point a Suboxone withdrawal is 4x worse than an actual heroin withdrawal. I think it's insanely reckless that people on here are recommending Suboxone/Subutex for depersonalization treatment. These are people who in large have probably not tried it themselves and if so are just being guinea pigs. I highly doubt Suboxone is going to cure or help anyone with DP. If you want to try it that's your call, but if it doesn't help I wouldn't stay on it long term. "
But, depersonalisation is a disorder of cognitive regulation of emotions with many brainstructures involved. This emotional regulation emotions starts at the prefrontal cortex and one structure can use dynorphin in the inhibition of anxiety, stress and addiction is the medial prefrontal cortex and it has been found to be active with other structures in the prefrontal cortex in functional brain studies of depersonalisation. So, emotional inhibition is also done by other structures in the prefrontal cortex that will not be affected by a opioid antagonist. But, these debates are kept alive by ignorants . You can inhibit that response in the medial prefrontal cortex with rTMS and some trails have done it in with people with cocaine addition. But, the right ventrolateral prefrontal cortex that is active in emotional regulation might not be a supressor by itself but likely to mobilised other structures in the prefrontal cortex to regulate emotions. To use rTMS at the right VLPFC will inhibit the instruction to regulate emotions given to other areas in the prefrontal cortex including the medial prefrontal cortex. A selective kappa antagonist if it existed would not cure depersonalisation disorder. It would likely give a reduction in symptoms of 20-30%
The role of the ventrolateral prefrontal cortex but also the angular gyrus in cognitive regulation of emotions can be read here.