TMS and DPD – The Evidence

DPD is one of the most difficult conditions for psychiatrists to treat. Currently, there aren’t any recommended treatments from the FDA (the Food and Drugs Agency in America) or NICE (the National Institute of Health and Care Excellence in the UK) and published research into the condition is also limited.

According to data, less than 2% of the world’s population has DPD – but many cases could be misdiagnosed.

TMS treatment offers hope for those affected.

Characterized by the “shutting down” of emotional responses, depersonalization disorder is hypothesised to be a result of a disruption in the limbic system and the temporal lobes.

These structures are predominantly involved in regulating responses to emotional stimuli, memory and integrating incoming sensory information with our internal representation of oneself.

fMRI studies have shown significant differences in the way patients with depersonalization and healthy controls process emotional stimuli and regulate emotional response.

In patients with depersonalization, their prefrontal areas (responsible for emotional regulation) are shown to be hyperactive, but their limbic areas (responsible for emotional processing) are underactive.

PET scanning in patients with depersonalization have also shown evidence of increased metabolic activity in the temporal and parietal areas. The Temporo-parietal junction (TPJ) incorporates information from the thalamus and the limbic system, as well as from the visual, auditory, and somatosensory systems. It also integrates information from both the external environment as well as from within the body.

TMS Treatment Evidence

For depersonalisation/derealisation disorder

There are two areas of the brain that have been trialed whilst researching how effective TMS is in treating DPD; the Temporoparietal Junction (TPJ) and the Venterolateral Prefrontal Cortex (VLPFC).

The Temporoparietal Junction

A study in 2000 showed that the brain scans of patients with DPD had increased activity on the right hand side, where the temporal and parietal lobes of the brain meet (behind and above the ear).

This study was the basis for further research into the brain’s response to electrical stimulation of the right TPJ. In 2005, it was found that this stimulation produced an ‘out of body’ experience for people not suffering with depersonalisation disorder.

By 2011, studies had progressed to show that by reducing the frequency of the stimulation, this over-activity was suppressed or calmed.

Mantovani studied a group of patients suffering with DPD, treating them with 15 daily sessions of low frequency TMS, over a three week period. This resulted in an average reduction of 50% in the patients’ DPD severity scores. He took this discovery further by treating a portion of his patients with a further 15 TMS sessions over a further three week period. On average, these patients saw 70% reduction in DPD severity following the full 30 session course of Transcranial Magnetic Stimulation.

The Venterolateral Prefrontal Cortex

Studies conducted between 2001 and 2007 revealed reduced brain activity in the right VLPFC, which is located in front of the ear and above the eye.

This prompted E.L. Jay to research how effective TMS treatment was over this brain area. Jay discovered that, following 20 sessions of treatment, the average reduction in symptom severity was 45%.

The verdict

Does TMS treat DPD?

On the basis of research into using TMS to treat DPD, evidence suggests that the patient will show signs of responding to the treatment within the first 5 sessions if they are going to see any response at all. In most cases, we will target the TPJ first, as this has a higher average decrease in symptom severity.

If we see a small but clear improvement in your symptoms within the first 5 sessions, you will be prescribed up to 30 sessions to maximise the effect of treatment. If you aren’t responding after the first 5 sessions, we will then try the VLPFC and analyse any improvements over this area, too. Up to 30 sessions would also be needed over the VLPFC if you respond well to treatment of this area.

In some cases, we don’t see any improvements so the decision to try TMS to treat your depersonalisation disorder is an individual one and it’s important that you’re informed by the evidence above.

Find out more

As you may have experienced with your regular GP or psychiatrist, DPD is very difficult to treat. Our friendly, knowledgeable team of patient advisors will talk you through TMS and the response/remission rates we have seen since offering treatment for depersonalisation disorder to help you make the best decision for you.

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