[dpdrhaver184]

A post was made recently called "why do multi-millionaires not spend money in research". It wasn't a very fruitful discussion.

So I wanna flip the question: If you were a multi-millionaire, how would you get us a treatment? What would your game plan look like? What would your research proposals be?

I would love some real-life answers. This question might not be purely theoretical : )

 

[NoDevils]

First I'd try to raise awareness of depersonalization so people can stop getting shrugged off or uncalled for schizophrenia diagnoses. Someone presenting with depersonalization can be monitored or even treated for schizophrenia without being wrongly told they're going psychotic. Awareness also helps sufferers because they can understand depersonalization is a common phenomenon and nothing to be scared of. Secondly I'd try to fund research so it can be better understood what are the causes of depersonalization, how to identify said causes, and what types of interventions are most helpful. Much of this has already been underway but compared to illnesses like depression and psychosis depersonalization syndrome is relatively neglected.

 

[ThoughtOnFire]

I would directly fund research on Consciousness itself. Because I believe a few things about it. First that DP/DR is mostly related to Consciousness, rather than brain chemicals. And that if there is Consciousness, then it can potentially be discovered/seen and experimented with via Science. In my case I think that my Consciousness is dislocated, just as a knee might dislocate. This all ties into the Hard Problem of Consciousness. Scientists are still working out whether or not Consciousness is real or an illusion of existence.

 

[nocturnalman]

No awareness and all that crap "awareness" my ass the majority of humans don't care about anything you can teach them about it day and night it won't make difference.Recruit people with dpdr and scan their brains to find a common pattern then from there look for medications.

 

[Trith]

If I were to spend a lot of money on DPDR, I would focus on understanding it and finding treatment and/or finding the right therapy. I think the best thing to do for that would be to ask for advice directly to researchers who have already worked on that topic. And ask them what would be the most efficient route according to them and the one that would have the best cost/rewards ratio. Perhaps screening a lot of DPDR people to identify common traits might help understanding how it works. I personally feel that in many cases long term DPDR is not simply stress related. People also might have more OCD traits, more narcissism, more overthinking, perhaps a worse identity construction during childhood, and then perhaps identifying those correlations might help identifying the mechanism that perpetuate DPDR for years and how to deal with them. But I would ask researchers.
And also I would want to learn how research can be privately funded. I work in scientific research (but not medical) and I have never encountered private funding. There might be some limitations with that. I know that with public funding agencies, people have pressure to make the project successful because if they waste the money it might reduce their chances to get further funding from that agency. But if it is a one time private fund there might not be the same pressure, although there is always an incentive to publish. There are probably different ways to fund research.

 

[NoDevils]

No awareness and all that crap "awareness" my ass the majority of humans don't care about anything you can teach them about it day and night it won't make difference.Recruit people with dpdr and scan their brains to find a common pattern then from there look for medications.

It's you who's being uncaring because you're triggered by the notion of acceptance. Millions of people will report depersonalization to their doctors and when their doctors react with confusion or stupidity this will hurt their patients. This is plainly evident in the amount of sufferers who've been told their depersonalization is a psychosis. The amateurish and undereducated population can scarcely tell the difference between 'dissociative' and psychotic disorders let alone conduct research on it which takes three times the effort or pays doctors three times less.

Tell me how someone can do neuropsychological or psychiatric research on depersonalization if they don't know what it is. Either way, you can wait around for a cure for this normal mental phenomenon which society is not prepared to resolve but I'm going to live my life to the best of my ability. What do you have to lose by living your life instead of waiting around for a cure? If you feel really disabled by depersonalization your best bet for assistance are a competent psychiatrist and a competent social worker and working within whatever your limitations may be to have some quality of life.

 

[Peter]

If I were to spend a lot of money on DPDR, I would focus on understanding it and finding treatment and/or finding the right therapy. I think the best thing to do for that would be to ask for advice directly to researchers who have already worked on that topic. And ask them what would be the most efficient route according to them and the one that would have the best cost/rewards ratio.

A first step would be to trial several medications and neuromodulation treatments that are already on the market, since a lot of them could potentially help on theoretical grounds. This could quickly introduce new treatment options.

 

[NoDevils]

A first step would be to trial several medications and neuromodulation treatments that are already on the market, since a lot of them could potentially help on theoretical grounds. This could quickly introduce new treatment options.

Isn't this already happening? I think everyone's suggestions in this thread including mine are already happening. So the answer the OP's question is to increase interest and funding. What Trith said about the way studies are funded is interesting.

 

[Peter]

Isn't this already happening? I think everyone's suggestions in this thread including mine are already happening.

No. There is almost no research on depersonalization disorder and currently no research on drug treatments.

 

[NoDevils]

No. There is almost no research on depersonalization disorder and currently no research on drug treatments.

Hmm. That sounds miniscule. Some psychiatric studies on depersonalization were conducted several years ago. I heard the clinics where depersonalization was psychiatrically studied are still providing treatment but the research has stopped. Why can't or why don't doctors turn their routine work into some kind of research? My doctor is conducting research on magnetic stimulation devices as part of a nationwide study on depression. Even with funding issues and lack of interest in depersonalization it's baffling that psychiatric research on the subject can be entirely stopped.

 

[dpdrhaver184]

A first step would be to trial several medications and neuromodulation treatments that are already on the market, since a lot of them could potentially help on theoretical grounds. This could quickly introduce new treatment options.

What stuff on the market right now do you think shows progress and is worth trialing?

 

[Peter]

What stuff on the market right now do you think shows progress and is worth trialing?

It's quite a long list:

• Lamotrigine obviously, because it worked in some small trials, but there is no randomized-controlled trial. It should also be investigated, whether adding an SSRI really augments it's effects or not.
• Same for naltrexone.
• Nalmefene, buprenorphine combined with naltrexone and selective κ-opioid-antagonists like Aticaprant and BTRX-335140.
• Clomipramine.
• Generally we need a new randomized controlled trial on SSRIs, because the trial of Simeon et al. (2004) suffered from a severe error: They excluded subjects, who tried fluxoetine prior to the trial, but not people, who tried any other SSRI or tricyclic antidepressant before. But this is low priority, because 20 years of online depersonalization communities suggest that response rates to SSRIs are likely to be low.
• Clonazepam, especially with consideration about the possibility of tolerance formation on long-term use.
• Levetiracetam, Brivaracetam.
• Topiramate
• Sarcosine
• N-Acetylcysteine
• Medications having an activating effect on the dopaminergic system, like some antipsychotics (aripiprazole, cariprazine), irreversible MAO-inhibitors (selegiline), stimulants, dopamine agonists. The reason is that antipsychotics often worsen depersonalization and the main mechanism of action of antipsychotics is blocking dopamine receptors.

Unfortunately none of that is going to happen any time soon, because depersonalization disorder is ignored.

 

[iamsufferingalotlmao]

It's quite a long list:

• Lamotrigine obviously, because it worked in some small trials, but there is no randomized-controlled trial. It should also be investigated, whether adding an SSRI really augments it's effects or not.
• Same for naltrexone.
• Nalmefene, buprenorphine combined with naltrexone and selective κ-opioid-antagonists like Aticaprant and BTRX-335140.
• Clomipramine.
• Generally we need a new randomized controlled trial on SSRIs, because the trial of Simeon et al. (2004) suffered from a severe error: They excluded subjects, who tried fluxoetine prior to the trial, but not people, who tried any other SSRI or tricyclic antidepressant before. But this is low priority, because 20 years of online depersonalization communities suggest that response rates to SSRIs are likely to be low.
• Clonazepam, especially with consideration about the possibility of tolerance formation on long-term use.
• Levetiracetam, Brivaracetam.
• Topiramate
• Sarcosine
• N-Acetylcysteine
• Medications having an activating effect on the dopaminergic system, like some antipsychotics (aripiprazole, cariprazine), irreversible MAO-inhibitors (selegiline), stimulants, dopamine agonists. The reason is that antipsychotics often worsen depersonalization and the main mechanism of action of antipsychotics is blocking dopamine receptors.

Unfortunately none of that is going to happen any time soon, because depersonalization disorder is ignored.

Hey, this list is great. Do you think you could come up with any other random ideas, meds, leads, or anything else you could list for me. Please. Thanks!

 

[Peter]

Hey, this list is great. Do you think you could come up with any other random ideas, meds, leads, or anything else you could list for me. Please. Thanks!

In terms of drugs that's all that comes to my mind at the moment. Transcranial magnetic stimulation on the ventrolateral prefrontal cortex, right TPJ and angular gyrus and vagus nerve stimulation could be worth a shot, too.

If you think about trying clonazepam, keep in mind that you will have an extremely hard time getting off it after taking it longterm and it's not certain, whether the anti-depersonalization effect isn't subjected to tolerance formation.

 

[iamsufferingalotlmao]

In terms of drugs that's all that comes to my mind at the moment. Transcranial magnetic stimulation on the ventrolateral prefrontal cortex, right TPJ and angular gyrus and vagus nerve stimulation could be worth a shot, too.

If you think about trying clonazepam, keep in mind that you will have an extremely hard time getting off it after taking it longterm and it's not certain, whether the anti-depersonalization effect isn't subjected to tolerance formation.

Ok thanks for the quick reply! I've done all the Benzos pretty much and recognize the hellish state you can end up with those. And I have also done TMS, although I'm not entirely sure the location. I'm thinking maybe Nalfemene right now, assuming its any different than just Nalterxone by itself (which I've already tried). Thoughts? Also can you elaborate on "irreversible MAO-inhibitors." Thanks, and sorry for the disjointed reply.

 

[NoDevils]

Ok thanks for the quick reply! I've done all the Benzos pretty much and recognize the hellish state you can end up with those. And I have also done TMS, although I'm not entirely sure the location. I'm thinking maybe Nalfemene right now, assuming its any different than just Nalterxone by itself (which I've already tried). Thoughts? Also can you elaborate on "irreversible MAO-inhibitors." Thanks, and sorry for the disjointed reply.

I hear if you got TCMS for depression it's not the same as for depersonalization. There was a poster here who knew a lot about that stuff, said the targeting equipment and target brain regions for depersonalization is rarer and more expensive. That was a few years back.

 

[Peter]

Ok thanks for the quick reply! I've done all the Benzos pretty much and recognize the hellish state you can end up with those. And I have also done TMS, although I'm not entirely sure the location. I'm thinking maybe Nalfemene right now, assuming its any different than just Nalterxone by itself (which I've already tried). Thoughts? Also can you elaborate on "irreversible MAO-inhibitors." Thanks, and sorry for the disjointed reply.

There is conflicting evidence in regards to nalmefene's speculative superiority. In a well-known study on emotional numbness in PTSD very high doses were required for it to work, while it performed well in lower doses in a more recent study on patients with borderline personality disorder. It was never specially tested for depersonalization disorder. If blocking kappa-opioid-receptors is the goal then nalmefene might not be much more practical than naltrexone, because both might require high doses, but at least nalmefene doesn't seem to cause liver toxicity.

Irreversible MAO-inhibitors are drugs that inhibit monoamine oxidase enzymes, which break down lots of neurotransmitters, including serotonin, noradrenaline and dopamine. They are used to treat treatment-resistant mental disorders, like treatment resistant depression and parkinson's disease. Due to their influence on dopamine I conjecture that they might help for some people with depersonalization disorder, especially these who get worse on antipsychotics. The most famous case who responded to a MAO-inhibitor is Jeffrey Abugel. However, generally there are only few reports about people whose depersonalization got better from MAO-inhibitors, but one reason might be, that many people did not try them.

 

[iamsufferingalotlmao]

There is conflicting evidence in regards to nalmefene's speculative superiority. In a well-known study on emotional numbness in PTSD very high doses were required for it to work, while it performed well in lower doses in a more recent study on patients with borderline personality disorder. It was never specially tested for depersonalization disorder. If blocking kappa-opioid-receptors is the goal then nalmefene might not be much more practical than naltrexone, because both might require high doses, but at least nalmefene doesn't seem to cause liver toxicity.

Irreversible MAO-inhibitors are drugs that inhibit monoamine oxidase enzymes, which break down lots of neurotransmitters, including serotonin, noradrenaline and dopamine. They are used to treat treatment-resistant mental disorders, like treatment resistant depression and parkinson's disease. Due to their influence on dopamine I conjecture that they might help for some people with depersonalization disorder, especially these who get worse on antipsychotics. The most famous case who responded to a MAO-inhibitor is Jeffrey Abugel. However, generally there are only few reports about people whose depersonalization got better from MAO-inhibitors, but one reason might be, that many people did not try them.

Ok, thanks for taking the time to write all that out. I will do some more investigating.

 

[joshuathornton76]

No awareness and all that crap "awareness" my ass the majority of humans don't care about anything you can teach them about it day and night it won't make difference.Recruit people with dpdr and scan their brains to find a common pattern then from there look for medications.

Ehhh this guy has got it. For the record, they have done brain scans. Our amygdala and surrounding areas are blunted (such as the prefrontal cortex). The amygdala processes emotion, feelings and stimuli. Sound familiar?

There would need to be billions of dollars to develop a drug that is safe and proven, and that is able to accurately affect the proper neurotransmitters. Kappa opioid antagonism is the best start.

 

[NoDevils]

Ehhh this guy has got it. For the record, they have done brain scans. Our amygdala and surrounding areas are blunted (such as the prefrontal cortex). The amygdala processes emotion, feelings and stimuli. Sound familiar?

There would need to be billions of dollars to develop a drug that is safe and proven, and that is able to accurately affect the proper neurotransmitters. Kappa opioid antagonism is the best start.

Isn't dissociation also common in people with "overactive amygdalae" like in EUPD and PTSD? I'm not sure how their depersonalization differs in presentation or what this would have to do with a hypothetical drug. This overactive amygdalae claim is something I heard from clinicians and not something I've studied myself. Regardless, trialing any medication is probably better than none. Psychiatrists have told me the goal of drug interventions now is to "normalize" certain systems. In emotionally unstable people they have hot, overly emotional moments as well as cold, empty moments and everything in between, so stability is a good goal for them.