[Ishmael35]

Hi all, I’ve been reading posts on this forum on and off for the last 10 years or so. I won’t give my whole backstory, but basically I have had depersonalization disorder, depression, and extreme anxiety for about the last 10 years. I also have near constant pressure and a “popping” sensation in my head, something that I believe is due to something being off with my sinuses. I feel this way basically constantly like many on here, but wanted to share what I am currently taking after tons of trial and error with different pharmacotherapies and other treatments, because they seem to help me most. For some background, I have tried many, many of the common drugs prescribed in many of the major categories (SSRIs, SNRIs, antipsychotics, benzodiazepines, stimulants, atypical antidepressants, other anti-seizure medication). I have also had ECT and TMS done, and have been to numerous ENTs and neurologists, who have never been able to identify the core of the problem. I don’t think most people on here have exactly the same symptoms as me, but I am certain we almost all overlap with the core symptoms and feelings. That being said, these are what I have found most helpful:

1. Lexapro - escitalopram. 30mg
2. Lamictal - lamotrigine. 200 mg
3. Ritalin - methylphenidate. 40-60mg
4. Klonopin - clonazepam. 2mg
5. Ultracet - 37.5mg tramadol/325 mg acetaminophen 2 times daily

Now I would not recommend taking all of these at the same time as I am unless you have a very high tolerance for medication, but these, individually and together, have provided the most medication-relief I have found. One of my biggest symptoms is the head pressure and “popping” sensation in my head, the reason for the Ultracet. But I would caution taking any analgesics (like tramadol, low strength synthetic opioid) other than NSAIDS (acetaminophen/ibuprofen/naproxen) unless you have similar chronic pain in your head/sinuses, because they are really easy to abuse.

I also know that many of these are hard to get prescribed in the US, especially at the same time, and trust me, like many of you I have had to practically beg psychiatrists to prescribe klonopin or other benzos. It’s taken me years to find a psychiatrist who will actually listen to me when I tell them what I know is helpful to me, and for that I’m thankful. So also don’t give up on psychiatry/psychiatrists, there are good ones out there, you just have to find them.

That’s it. I won’t give an exhaustive list of all the medications I’ve tried unless someone wants to know, but I hope if you do see this, know there is hope and to keep going, even with a chronic and sometimes debilitating condition. Things can and will get better. These are just medications, and of course the whole other part is therapy, staying social, eating right, exercising etc. But i also know that sometimes you can’t bring yourself to do these things that will help if you are too depressed or too anxiety ridden, and that’s where medication fills the gap for me. We are all a work in progress in this life, just like everyone else, even if we feel disconnected from the world at times. You are normal and sane, even if it doesn’t feel that way sometimes. Much love to everyone who suffers with this every day. Feel free to DM me for any more information if you want

 

[Trith]

Hello, could you please say what helped you specifically with common DPDR symtoms? Like not feeling real, loosing the feeling of familiarity with yourself and others... Also if you don't mind, for how long did you try these different medication and do you experience any side effects today? I'm asking because I have always been afraid that taking medication could have long lasting side effects. I have had weird reactions to some medication, and the fact that psychiatrists did not expect them or sometimes don't even believe me I had them, makes me not trust them very much when they say long lasting side effects are extremely rare. I clearly had things they didn't expect or didn't know about. I have also still have worse memory and attention since I took some treatments, that I all stopped last fabruary. There is some non zero chance I might try some ritalin in the future, if it's really needed, but I would like to hear other people's experiences.

 

[Ishmael35]

I would say generally, at the beginning, lexapro was the most helpful for me. The first time I took it after I had my first dp/dr episode, I felt like it brought me back to life. My hypothesis is that although it kind of numbed my emotions at the beginning, it reduced my baseline anxiety enough that my brain could start to relax and feel things again - it felt like something almost physically reconnected in my brain. This kind of tracks with the neurobiological hypothesis of depersonalization/derealisation, which is that faced with overwhelming threat/anxiety/stimuli, there is a neural mechanism for shutting this down for self-protection. We just have this mechanism chronically active and potentiated, whereas most people would have a transient dp/dr experience.
After this, of course, I was an idiot and kept smoking weed, which led to another “break” with reality and my emotions, and started all my sinus issues and head problems. I have never really fully recovered from this, and have never had the feeling of being “brought back,” so to speak, like with the lexapro.
I have taken lexapro on-and-off for about the last 10 years. It has been the one antidepressant that I have consistently come back to, due to unpleasant feelings/side effects on all the other ones I tried, and it is the one that I have realized I can tolerate the best and helps the most. The trial and error of taking medications is that they all have side effects, and finding one that is tolerable and helpful is different for every person, so I hear what you’re saying about side effects. Personally, any long-term side effects from these drugs I believe are negligible, and even if they are, are worth it to me to treat the condition I have, which I believe untreated would have a much more drastic long-term effect on my brain and mental health. No one can say for certain whether these medicines won’t physically change your brain over the long-term or cause long-term side effects, and I believe that risk-benefit is a choice everyone who takes medications like these has to make on their own.
I’ll just list some of the side effects I’ve experienced on some of the drugs:
Lexapro - dry mouth, some numbness of feeling, sometimes a little more detached from the moment.
Lamotrigine - no major ones, a rash that wasn’t serious, but a very serious rash can occur on this one but is extremely rare
Ritalin - if taken too fast or too much, can cause anxiety. But also the one that perhaps more than the others helps me feel grounded and able to do things
Clonazepam - sometimes a worsening of depression, feeling spacey. But also can control extreme anxiety and make you feel more attached to reality and emotions
Tramadol/acetaminophen - wouldn’t really recommend this unless you really need it. Side effects for me are sometimes more popping in my head, increased anxiety, dissociation. But also can help with extreme head pain and helps with obsession and ruminating thinking, and can lower anxiety.
The one I absolutely don’t recommend is ECT. That I am sure has had a long tasting impact on my brain, and took me years to recover from. There is a lot of promise in TMS, but it didn’t help me that much.
Again, with all these meds, it’s measuring the side effects and feelings against what they do for you, and taking them in manageable doses that take time to be adjusted and find the right dose. For me, this is the best I’ve found. I wouldn’t recommend anything specific, as everyone has found success with different meds. Stimulants for me, for example, generally calm me down and make me more grounded, but can also cause anxiety if too much is taken too fast.
Moral of the story, I wouldn’t give up on drugs or be afraid of them, but also don’t discount the effects they have on you. If you can
manage without them all the better, but I know for myself I would be much more miserable without them. Hope this helps

 

[Aridity]

I would say generally, at the beginning, lexapro was the most helpful for me. The first time I took it after I had my first dp/dr episode, I felt like it brought me back to life. My hypothesis is that although it kind of numbed my emotions at the beginning, it reduced my baseline anxiety enough that my brain could start to relax and feel things again - it felt like something almost physically reconnected in my brain. This kind of tracks with the neurobiological hypothesis of depersonalization/derealisation, which is that faced with overwhelming threat/anxiety/stimuli, there is a neural mechanism for shutting this down for self-protection. We just have this mechanism chronically active and potentiated, whereas most people would have a transient dp/dr experience.
After this, of course, I was an idiot and kept smoking weed, which led to another “break” with reality and my emotions, and started all my sinus issues and head problems. I have never really fully recovered from this, and have never had the feeling of being “brought back,” so to speak, like with the lexapro.
I have taken lexapro on-and-off for about the last 10 years. It has been the one antidepressant that I have consistently come back to, due to unpleasant feelings/side effects on all the other ones I tried, and it is the one that I have realized I can tolerate the best and helps the most. The trial and error of taking medications is that they all have side effects, and finding one that is tolerable and helpful is different for every person, so I hear what you’re saying about side effects. Personally, any long-term side effects from these drugs I believe are negligible, and even if they are, are worth it to me to treat the condition I have, which I believe untreated would have a much more drastic long-term effect on my brain and mental health. No one can say for certain whether these medicines won’t physically change your brain over the long-term or cause long-term side effects, and I believe that risk-benefit is a choice everyone who takes medications like these has to make on their own.
I’ll just list some of the side effects I’ve experienced on some of the drugs:
Lexapro - dry mouth, some numbness of feeling, sometimes a little more detached from the moment.
Lamotrigine - no major ones, a rash that wasn’t serious, but a very serious rash can occur on this one but is extremely rare
Ritalin - if taken too fast or too much, can cause anxiety. But also the one that perhaps more than the others helps me feel grounded and able to do things
Clonazepam - sometimes a worsening of depression, feeling spacey. But also can control extreme anxiety and make you feel more attached to reality and emotions
Tramadol/acetaminophen - wouldn’t really recommend this unless you really need it. Side effects for me are sometimes more popping in my head, increased anxiety, dissociation. But also can help with extreme head pain and helps with obsession and ruminating thinking, and can lower anxiety.
The one I absolutely don’t recommend is ECT. That I am sure has had a long tasting impact on my brain, and took me years to recover from. There is a lot of promise in TMS, but it didn’t help me that much.
Again, with all these meds, it’s measuring the side effects and feelings against what they do for you, and taking them in manageable doses that take time to be adjusted and find the right dose. For me, this is the best I’ve found. I wouldn’t recommend anything specific, as everyone has found success with different meds. Stimulants for me, for example, generally calm me down and make me more grounded, but can also cause anxiety if too much is taken too fast.
Moral of the story, I wouldn’t give up on drugs or be afraid of them, but also don’t discount the effects they have on you. If you can
manage without them all the better, but I know for myself I would be much more miserable without them. Hope this helps

How long did it take for you that the lexapro started working? I just started it and I feel way worse I am on day 17 of 5mg, worsening brain fog en detachment overall.. I have been on it before, and back then it did not make me feel the way it does now. But I always quit too soon...

 

[Ishmael35]

I would say for me, I felt the effects almost immediately when I first started. They were mostly good, I felt a little more detached but my anxiety was way lessened. I was taking 10 or 20mg then too, and am now taking 30. I would say if you still feel bad on just 5mg after a month, it probably won’t get better. They do say it takes up to two months to truly reach the peak effectiveness, but I feel I’ve always hd a pretty good idea by 1 month. But if it’s really that intolerable and is making things worse like increased brain fog on that low a dose, I kinda doubt it’s the medication for you. Worth sticking it out a bit longer, and maybe upping to 10mg, to see if things get better, but if it’s still bad or worsens, probably better just quitting and trying something else.

 

[egmonton]

I can relate to your struggles with depersonalization disorder and anxiety. It's a tough road to travel, but I'm glad you've found some medications that are helping you. It's important to remember that medication is just one part of the solution. Therapy, exercise, and a healthy lifestyle are also important.
I wanted to mention that it's important to be careful when taking opioids like tramadol. It's always best to follow your doctor's advice and take medication as prescribed.
On a side note, I recently came across a site offering to buy tramadol near me. While it may seem like a convenient option.