[silverhawk]

Ok so I recently met up with my psychiatrist and he told me that an anti-depersonalization medication will not come out in our lifetime for 2 reasons: the cause is unknown and not enough people have depersonalization disorder in order to spend money on the research of DPD. Do you think he's right? I'm scared that I'll have DPD for the rest of my life... Hopefully my psychiatrist is wrong and an anti-DP medication will come out soon..

 

[Guest]

There's plenty of recovery stories on here and on the internet to prove this professional wrong.

You got to accept your DP/DR, go along with it (Ignore) and recover, and if possible, stay away from meds.

 

[Guest]

That was what I said but more condensed, lol.

 

[TDX]

Next year ALKS-5461 might become available and this is most certainly an anti-depersonalisative medication. If we look at the studies of Nuller et al and Simeon et al it and assume that the effects come from kappa-opioid-antagonism it might benefit 30 % - 70 % of us.

As I see it there are various lines of possible treatments for depersonalization, including medication, neuromodulation and - to a limited extend - psychotherapy which should be investigated. The only problem is that there is no interest in psychiatry to do this. In my opinion the often quoted treatment-refractoricity of depersonalization is to some extend homemade.

 

[TDX]

More and more I'm getting a strong disgust towards this never-ending trauma-ignore-acceptance-folderol.

 

[TDX]

Couldn't agree more. I just can't understand these people who have been suffering for years spouting this anti-treatment diatribe. If there's something that could help them, any sane person would try it, right?

At least I decided for me to bring the artillery of psychopharmacology into position. I'll try everything that might help and that I can get prescribed. If nothing works I'll also try to get electroconvulsive therapy (although I think that chances are fairly low).

I'll also try psychotherapy, but I don't really believe that it can help. There is no convincing concept for a psychotherapy against depersonalization, especially not from the dissociative-disorder-community. The only things that might justify further investigation are abreaction and maybe mindfulness meditation.

Nope. Apparently we should suffer quietly and eventually maybe our purity will guide us home.

Unfortunately this is what many actually do. Although depersonalization disorder might affect 1% of the population there are no self-help organizations that advocate the interests of the depersonalized. This is because I think that the ignorance of psychiatry is partly a fault of the sufferers themselves, who did not stand up to fight for their rights.

Zed named you as one of the people who finally chased him off this forum btw. We did good. Keep acting as a voice of rationality.

He was another reason why I got suspicious that the dissociative disorder community might be a reservoir of all the charlatons in psychiatry. I don't believe them that they can treat depersonalization or any other of the dissociative disorders.

 

[inferentialpolice]

King and TDX, for whatever it may be worth, here is part of an PM I received from Zed just prior to his leaving:

"It saddens me that therapy gets such a bum rap on this site. I've been on a few sites for dissociative people (mainly DID sites) and I've never seen anything like what I see here on DPSH. I've never seen so much denial! Or confusion as to what the dissociative disorders are (for the large majority of ppl). I can see it must be bewildering for someone who believes their upbringing was close to perfect, but there're many people who absolutely know their upbringing was far from ideal yet don't seem to want (or are able?) to acknowledge the connection with their DD... At the same time I do understand there're few folks who don't have this disorder from trauma.

I've seen a couple of great therapists; a psychiatrist weekly for 2 years and then I moved on to a psychologist who I see presently. I've been seeing her pretty much weekly for about 16 months. Though I should never forget the first person I ever saw who was a counsellor. I saw her weekly for about a year I think it was. She was great too and recognised very quickly that I was extremely dissociative.

The psychologist I see now also has a great understanding of DID and DD's and we talk a lot about the DD's in general. She and her peers absolutely believe over 90% of people with DD's have trauma in their background. She also said in her 20 years of experience, it's not uncommon at all to hear the words "my family life growing up was great" and further down the track the 'walls' begin to crumble and the truth comes out to discover a very abusive past...

I've learnt a hell of a lot about this condition from a couple of other forums too. The folks on 'Survivorship.org' have been incredibly helpful and that place really stands out. It's a site for people with DID.. and the thing is.. there's plenty of ppl there who've walked the long journey, come out the other side and DO lead content and fulfilling lives. What better people to talk to than the ones who've spent decades in therapy, healed and are willing to lend a hand? It's not unusual for them to go on and become counsellors or therapists.

There's a few things on this site I feel are neglected. Where's the talk and understanding of triggers and they impact they can have? Where's the advice about how powerful grounding is for dissociative people? Where's the talk about the need to feel safe and the huge impact that can have on fuelling dissociation? I've brought these topics up occasionally but they don't get much traction.. Ahh well.. you know they say, 'you can lead a horse to water….'

 

[TDX]

There's no real point in me responding to that nonsense given that he'll never read it but if he was here, I'd challenge him to find 10 stories in the recovery section that begin with "I started seeing a therapist"

In my opinion psychotherapy for DPD is - at least in most cases - useless. It may help some people to cope with their symptoms, but in most cases do nothing to actually reduce them. And therapies which have a duration of decades point to quackery, because there is no scientific evidence for the efficacy or long-term psychotherapy (which is almost always psychodynamic) for any disorder.

*Myself and TDX et al. are the ones who advocate trying everything -- psychiatric and psychological. We say throw everything you can at DP and see what sticks. It's the rational course of action.

That's true.

 

[Guest]

I'd say your psych is first off a jerk for giving you the no hope speech in certain times of need, but i've seen a lot of jerks in that field over the years. They get the MD and turn into gods among men. However, He's right about one thing, we may not see it in our lifetime. Mental illness is a fickle bitch, you can't take the mind and point to the problem like you can with say an x ray of a broken bone. Even with more severe illness' such as schizophrenia, it's very difficult to diagnose and usually a diagnosis is only made with subjective information.

I wouldn't lose hope just yet though, there are ways to cope, and i still believe getting to the root cause of the DP can cure it. For example if yours was caused by trauma, anxiety, or a subconscious version of both, it can definitely be fixed.

 

[TDX]

I wouldn't lose hope just yet though, there are ways to cope, and i still believe getting to the root cause of the DP can cure it. For example if yours was caused by trauma, anxiety, or a subconscious version of both, it can definitely be fixed.

In my opinion this view is part of the problem, because it directs the attention to trauma, anxiety and so on with the consequence that depersonalization is ignored.

 

[Guest]

In my opinion this view is part of the problem, because it directs the attention to trauma, anxiety and so on with the consequence that depersonalization is ignored.

I don't see how depersonalization can come on without a root cause behind it, unless of course it is something neurological. Do you?

 

[TDX]

This depends on how you define "root cause". In your post the root causes seem to consist of other mental disorders, so your statement is that depersonalization is caused and mantained by other mental disorders. This is not true, because in the literature there are numberous examples where medication worked for the preexisting mental disorders, but not for the depersonalization.

 

[Guest]

Everything I've read has defined DP as a symptom of other mental disorders, however, lately I'm starting to agree with the fact that it can be more of a progressive disorder for some, including myself. So I guess I half agree with you on this. For some it merely is a symptom with an underlying root cause, but for others, it's a disease in and of itself. I think you may be more knowledgeable on the subject then myself so I am not one to argue!

 

[TDX]

I'd typically expect benzos to only reduce DP symptoms in someone whose DP is secondary to an anxiety condition or similar. For me, for example, benzos do nothing except make me care slightly less about having DP, which allows me to plod through each day.

I don't know how they work, but increased GABA-activity might be able to decrease glutamatergic activiy in such a way that some people's symptoms are reduced. Interestingly it was found out that in soldiers Neuropeptide-Y concentration inversely correlated with "dissociation" (which almost always depersonalization). Neuropeptide-Y is thought to be a GABA_A-agonist, just like benzodiazepines.

No therapy, informal work on my condition or medication has had the slightest effect on the intensity of my symptoms.

What medications did you try? Maybe I've some ideas which you might check out.

On a personal note, if I fail to respond to TMS in a couple of months' time, I'm going to do a better job of ending my life. It would be easier if guns were legal in this country. Some people have no hope. Sorry for the bad news, newbies, but that's how this condition works.

Do you know what part of the brain they will stimulate? DPFC? VPFC? TPJ? Angular gyrus?

 

[TDX]

As I see you have not yet exausted all options. You may try Clomipramine, other anti-convulsives (Keppra, Topiramate), opiod antagonists or dopaminergic medications before you seriously try to commit suicide. In my opinion you should definetly try to get hold of Nalmefene. But I know by myself that this is easier said than done.

By the way: I tried St. Johns Wort, Escitalopram, Duloxetine, Clomipramine, Mirtazapine, Seroquel, Tianeptine and Bupropion without success for my "depression". The next thing might be Agomelatine, but only because I want to test if it can be used as a "time machine" just like Mirtazapine and Seroquel.

Obviously I'm not going to commit suicide* without scamming a doctor (alcohol addiction ftw) or robbing a pharmacy for naltrexone first so there's at least 2 treatments I've still got to try. I'd steal some IM naloxone but I think that's very much a special order item in this country.

Scamming doctors might also be a good idea. Sad that we have to resort to such things. But before this it's important to know if this could have bad consequences.

The kappa-selective bupenorphine combo (ALKS-whatever) most likely won't be widely available here in the UK for years.

Why? It seems to be very succesful for depression. DP might be ignored, but I don't think they will deny depressed people a very effective medication.

My previous attempt was pretty half-hearted. I kinda expected to wake up after several days. It turns out that even my entire prescription of diazepam taken at one time isn't a lethal dose.

I also had a half-hearted attempt by trying water intoxication while having a bath. Unfortunately this is very hard.

 

[TDX]

Is there any supporting evidence for TCAs at all? I've never seen anything in the literature.

There are some case-reports for clomipramine and desipramine:

http://europepmc.org/abstract/med/3435887
http://www.sciencedirect.com/science/article/pii/S0006322398000237
http://journals.cambridge.org/abstract_S1092852900009366
Michelson, Larry K., and William J. Ray. Handbook of dissociation: Theoretical, empirical, and clinical perspectives. Springer Science & Business Media, 1996. Page 300

I also read on the forum that some people had success with Clomipramine. But just like SSRIs the odds seem to be quite low.

By dopaminergic medications, I assume you mean receptor antagonists. From that class, I've obviously already tried prochlorperazine but never any atypical antipsychotics, which seem to work for some people.

No, I mean dopamine-increasing drugs, like Bupropion, Selegine, Ritaline, Adderal, Pramipexol and so on.

But atypical antipsychotics also work for some people, but in the majority antipsychotics make.things worse.

I'm still a member of a private online drug market so that will be my first port of call. I'll ask around about nalmefene as well. If I manage to get hold of some, I'll let you know and if you're interested, help you out.

Just post in on the forum.

 

[TDX]

Btw, have you tried naltrexone? If not, would you be interested? I'm going to see if I can get some.

I would prefer Nalmefene, because Naltrexone can be live-toxic in the high dosage that is required to block the kappa-opioid-receptor. Nalmefene also might have an anti-PTSD-effect while Naltrexone does not, which might be a hint that Nalmefene is better suited to treat depersonalization.

I'd like to try Nalmefene or Naltrexone but the problem is that my parents would be very angry if they found out that I got it illegally. Next year ALKS-5461 should come anyway, so in the meantime I'll try to get the other things.

By the way: If you are able to get medication illegally you could build ALKS-5461 by yourself. Combining Naltrexone and Buprenorphine in a 10:1 ratio seems to result in a functional kappa-opioid-antagonist:

http://www.nature.com/clpt/journal/v83/n4/abs/6100503a.html

http://onlinelibrary.wiley.com/doi/10.1111/adb.12020/full

http://jop.sagepub.com/content/20/6/806.short

I actually suggested this while I was in a psychiatric clinic, but of course they said no.

Funnily enough, regarding dopaminergic drugs, I've actually felt worse ever since I stopped doing speed. I gave it up cold turkey about a year ago after a three year habit. I believed, incorrectly, that it was playing a role in perpetuating my condition. Maybe it wasn't.

This might be caused by kappa-opioid-upregulation:

http://link.springer.com/article/10.1007/s00213-010-1825-8

Interestingly dopamine-antagonists did not increase your symptoms. Maybe this also point to the kappa-opioid system.

 

[TDX]

Is there any evidence that nalmefene works for DP?

No, but I've read in the forum that the depersonalization research unit in London uses it.

I mean, it's a partial agonist at KORs so not a mechanism that I've ever seen tested.

A weak partial agonist might be expected to work just like an antagonist. Buprenorphin is also a weak partial agonist.

Regardless, all the evidence seems to suggest that the kappa-opioid system is one of the primary players in DP and the future looks bright with ALKS-5461 on the horizon.

I suppose it will work for a substantial number of patients, but it won't solve all depersonalization problems.

There also seems to be some inherent value in stimulants for a subset of DP sufferers. Whether this is through a pharmacological mechanism, I have no idea. I'd hypothesise that the focus and mental clarity that you get on amphetamine etc. makes DP a lot easier to ignore and, given time, could ease the symptoms (or at least prevent further worsening).

The mechanism by which stimulants improve DP-symptoms might be the same, by which antipsychotics make them worse. Unfortunately I wasn't yet able to figure out why antipsychotics make DP worse. The answer might be out there, because one should expect that in psychosis research they've accumulated a huge knowledge of the effects of D2-antagonists. Maybe it's related to glutamate.

But the problem is that Antipsychotics don't make Ketamine-induced DP worse. But this could mean that no effect of antipsychotics might predict response to Lamotrigine or ALKS-5461.

 

[TDX]

I think it's reasonable to expect ALKS-5461 to perform at least as well as naloxone for which the only available data is extremely promising (~70% response, as you already know).

Difficult to say. In Nullers study there were also people who may have had DP secondary to treatment-resistant depression, while in Simeons study all had primary DP. But in Simeons study most participants did not reach the highest dosage, while in Nullers study they got infusions until it worked. So I assume that the real response rate might lie between 30 and 70%. Even 30% would be significant.

In the general case, classical anti-psychotics still make most people feel worse. I'm the oddball exception to almost every rule.

Seroquel didn't make me worse, too.

Classical anti-psychotics actually weaken some of the effects of ketamine, I think, which is interesting but only really suggests a dopaminergic component to the ketamine experience. Not necessarily at odds with what we already believe.

In fact Ketamine is also a partial D2-agonist. But haloperidol didn't reduce most of it's effect and this also includes the dissociative.

What do you think about iboga/ibogaine anyway? So far I've only skimmed the wikipedia article but I want to look into it properly

It's definetely not safe. I would never take it under any circumstance.

We have two completely different pharmacological options that have both yielded peak response rates of ~70% in the literature

Unfortunately that's not sure for Lamotrigine. The study of Aliyev and Aliyev is a complete fake (they copied most of the data from a trial about another disorder they conducted some years before). I conjecture that Lamotrigine works quite good for some people, but while reading this forum I came to the impression that the odds are much lower than the study suggests.

Anyway, I think the future looks very bright in terms of psychiatric treatments. The "treatment refractory" label so often applied to DP is a crock of shit.

I wouldn't get so far, yet. But I'd say that the refractoricy of DP is the fault of psychiatry.

That's not a bad idea actually, TDX. We should make a list of every single class and drug within those classes that we believe could be efficacious for DP. A DP shopping list! We've both done a lot of research. We should share it with everyone else in some kind of accessible form.

The real problem would be to get them prescribed.

 

[TDX]

Regarding the Nuller study, the fact that naloxone isn't indicated for depression makes me think that the drug was affecting DP directly.

This might be the case, but DP in depression may be different from other DP and thus more responsive. We just don't know.

I stand by my statement that the "treatment refractory" label is wrong. Even if we reassign response rates for various treatments to be more conservative - let's say 50% for naloxone, 40% for lamotrigine (+ SSRI) and 50% for TMS - those numbers match and exceed their counterparts for other mental health conditions that aren't given the "refractory" label.

The problem is that this assumption is based on a small number of low-quality studies, while in other mental disorders there is more reliable data. Should ever more rigerous study be done those numbers might sink. Concerning TMS it is to note that this treatment was researched for many disorders in the last 2 decades, but still TMS is not well established in any disorder.

But I think that it's true that a substantial number of DP'ers could be treated - if psychiatry wanted to.

Have you got any proof that the Aliyev study is fake? I know it was retracted but that was for a relatively minor act of plagiarism. If the data was fabricated, I'm surprised nothing about it was in the retraction notice.

These suckers just copied the data of this study:

http://www.sciencedirect.com/science/article/pii/S0924933807013673