Dear Tom,
Its just my opinion, but I think that there are 2 reasons for that. In that study they noticed that fluoxetine with lamotrigine seemed to up the efficacy to something around 60 percent cured or greatly improved ( I read this study a while ago). (1) As I said before, anecdotal evidence has shown that while SSRIs help with the obsessions which occur with DP, it can intensify the rages from unknown sources, inner monologue being increased, feelings of DR and DP....and the worst was actually found to be fluoxetine in this regard. Perhaps the efficacy would have been higher had they used something milder, and with far less side effects, like Celexa, or proven on its own to help, like Anafranil. Either way, they tend to help with obsessive thinking in DP, thus their use together (2) I tend to think that DPers with hypergraphia, existential thoughts, mood swings, etc...whose symptoms are not responding as one would like to with one anticonvulsant should try adding a gentler one with it too see if it works as an "adjunct" therapy, just as is done with epilepsy. Using only one anticonvulsant in epileptic medicine is known as "monotherapy", and we know that this doesnt always stop seizures. Thats why I would consider Lamictal and Klonopin, without an AD to be a "DP killer". One could always add Celexa or Anafranil to that mix for obsessiveness, but only if necessary. Of course, this is only my own theory on the matter, but if I were ever to make it through med school and start a DP clinic, this is what I would recommend with today's medicine. I dont think this would work with the "washed out" DP that some drug users have, where their affect feels "flat" and colors look grey, etc...I beleive that is a depressive state that comes from a brain exposed to far to many drugs, and can probably be remedied best by nutrition, B vitamins, abstinence, and antidepressants. I also dont think this will work with DPers with a strong element of HPPD. I also beleive that to be a completely different animal, with brain irregularities which expand far beyond the temporal lobe. For marijuana use induced DP and non-drug induced, however, I believe this will work, and those are the vast majority of DPers I have seen.
Peace
Homeskooled