From the Research
The most effective treatment approach for depersonalization disorder involves a combination of pharmacotherapies, such as selective serotonin reuptake inhibitors (SSRIs), lamotrigine, and clonazepam, alongside psychotherapies like cognitive behavioral therapy. Based on the most recent and highest quality study available 1, which conducted a systematic review of treatments for depersonalization-derealization disorder, it is clear that a multifaceted approach is necessary. The study found that while various treatments have been applied since 1955, the quality and quantity of studies were generally low, highlighting the need for more high-quality research. However, some key findings and recommendations can be made:
- SSRIs, such as sertraline (50-200 mg daily), are often considered first-line treatments due to their ability to regulate serotonin levels and reduce dissociative symptoms when taken consistently for 6-12 weeks.
- Lamotrigine (starting at 25 mg daily, gradually increasing to 200-300 mg daily) may be particularly helpful for persistent cases by stabilizing glutamate activity in the brain, though it requires careful titration to avoid skin reactions.
- Clonazepam (0.5-2 mg daily), a benzodiazepine, can provide immediate relief by enhancing GABA activity but should be used cautiously due to dependence risks and is best for short-term or intermittent use.
- Psychotherapy, particularly cognitive behavioral therapy, is often more effective when combined with these medications, as it helps patients address underlying issues and develop coping mechanisms. It's essential to note that treatment response varies significantly between individuals, so medication trials under psychiatric supervision are necessary to determine the optimal approach for each person experiencing depersonalization symptoms 2, 1.