From the Guidelines
Depersonalization/Derealization Disorder acute treatment is not directly addressed in the provided evidence, however, based on general medicine knowledge, the treatment typically involves the use of selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine, starting at a dose of 20mg daily, which may be increased to 40-60mg daily after 4-6 weeks if symptoms persist 1. Additionally, clomipramine, a tricyclic antidepressant, may be considered at a dose of 25-50mg daily, with gradual increases up to 200mg daily as needed and tolerated.
- Benzodiazepines, such as clonazepam, may be used in the short-term for acute anxiety and agitation, but their use should be limited to 2-4 weeks due to the risk of dependence.
- It's worth noting that ketamine and esketamine have been studied for the treatment of depressive symptoms, but their use in depersonalization/derealization disorder is not established 1.
- The provided evidence primarily discusses the treatment of major depressive disorder, and while some treatments may overlap, the specific treatment of depersonalization/derealization disorder should be guided by clinical expertise and patient-specific factors.
From the Research
Acute Treatment for Depersonalization/Derealization Disorder
The acute treatment for Depersonalization/Derealization Disorder is not well-established, but some pharmacological approaches have shown promise:
- Opioid receptor antagonists such as naltrexone and naloxone may be useful in a subgroup of patients 2
- The use of lamotrigine as an add-on treatment with selective serotonin reuptake inhibitors (SSRIs) may be beneficial in a substantial number of patients 2
- Clonazepam, particularly in conjunction with SSRI antidepressants, may be beneficial in patients with high levels of background anxiety 2
Comparison with Other Disorders
While the treatment of Depersonalization/Derealization Disorder is not well-established, the treatment of other disorders such as major depression and panic disorder may provide some insight:
- SSRIs are commonly used in the treatment of major depression and panic disorder, and may be effective in the lower range of their licensed dose 3, 4
- The use of SSRIs in the acute treatment of major depression may increase fear, but chronic treatment may reduce fear 5
- SSRIs and benzodiazepines may have different side effect profiles in the acute treatment of panic disorder, with SSRIs causing more adverse events such as diaphoresis, fatigue, and nausea 4