Parts of the prefrontal-cortex of the brain are modulators of emotions. They can filter and suppress anxiety so one can work it out. They can also filter social pain to social exclusion, trauma so it is not felt to painfull. These areas are very active in depersonalisation and have stopped filtering but takes all emotions. That makes the emotional numbing. So, emotions isn't gone but they are not felt due to this mechanism. In depersonalisation it is thought that overactivity of the right ventrolateral prefrontal cortex makes the numbing and the sense of a loss self.
emotional numbness
Compassionates,
can somebody explain, how somebody can get "overnight" in emotional numbness ?
can somebody explain, how somebody can get "overnight" in emotional numbness ?
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Typically anxiety, trauma and stress. These networks in the frontal cortex are modulators of emotions and found to be overactive in depersonalisation disorder.Hello Mayer-Gross,
what could be the reason for the changing of the frontal lobe ?
You can read this based on emotional processing in DP from fMRI scans about emotional numbing from suppression from the right DLPFC and the right VLPFC .https://www.frontiersin.org/articles/10.3389/fpsyg.2016.00432/full
This one might interest you from you history. You shall be aware that THC might make depersonalisation but people who gets depersonalisation from THC often have a history of panic attacks and might have mobilised these networks before unaware of it. So, THC is more a tricker.https://www.ncbi.nlm.nih.gov/pubmed/10442442
Yes. i have emotional numbness. rTMS is difficult in depersonalisation because of the locations that is under suspicion. Typically rTMS is given to the left and right DLPFC that is pretty easy to locate. Some with DP have a response to that particularly is depression is present so depersonalisation might be secondary to the depression. The area that is under suspicion to make the inhibition of emotions is the right ventrolateral prefrontal cortex. It is difficult to locate and typically you have to have equipment to make neuronavigation from a MRI scan. So, a MRI scan of the whole surface of the brain has to be taken to calibrate from. 90% of the rTMS clinics can't do that. I only know of one private clinic in Europe that can do that and they didn't know about DP,- said they would look into it.https://www.localite.de/en/products/tms-navigator/
I know about a rTMS clinic in Holland who has treated 10.patients within the last year and 4. responded. They do not have neuronavigation and their potecal for depersonalisation is Low frequency the the right DLPFC at first, high frequency at the right DLPFC,- that is a typically used for depression. The low frequency at the right DLPFC might take some numbing in some. Then they try the right TPJ. That is difficult to locate without neuronavigation. They do not go after the right VLPFC that is the most potent inhibitor of emotions,-they cannot locate it. Without neuronavigation you are more limited and it open of for a lots of errors.
A large trial in France with more than 100.patienter given rTMS at the right angular gyrus has just finish and it is an area similar to TPJ that making some others symptoms in DP. Two networks might make the disorder. The numbing form the inhibition from the frontal cortex and other symptoms angular gyrus or TPJ that is also part of the "default mode network". So, you like have to work with two networks with rTMS.https://clinicaltrials.gov/ct2/show/NCT02476435
A large trial in France with more than 100.patienter given rTMS at the right angular gyrus has just finish and it is an area similar to TPJ that making some others symptoms in DP. Two networks might make the disorder. The numbing form the inhibition from the frontal cortex and other symptoms angular gyrus or TPJ that is also part of the "default mode network". So, you like have to work with two networks with rTMS.https://clinicaltrials.gov/ct2/show/NCT02476435
As mono-therapy lamotrigine has not shown any effect but in some trails in a combination with a SSRI or SNRI 50% showed a 30% reduction. The typical dose people respons to is 200-300.mg of lamotrigine. Yes, i think rTMS in Holland have several locations it is the same people. Inhibition of the right DLPFC is the most important. All rTMS trails done in depersonalisation has used neuronavigation. The TPJ in New York, the right VPLFC in London and the right angular gyrus in France.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3968882/
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