Depersonalisation Disorder

Condition

Depersonalisation disorder (DPD), is a mental disorder which involves persistent or recurrent feelings of depersonalisation and/or derealisation.

It is sometimes known as depersonalisation-derealisation syndrome.

It is among the most common yet under-recognised psychiatric conditions in the world. According to studies DPD could affect up to 2% of the population in the UK – 1 in 50 – which equates to around 1.3 million people. That is similar to the numbers suffering from schizophrenia or OCD (Obsessive Compulsive Disorder), yet as the condition is misunderstood, many people struggle to get a diagnosis or treatment.

Symptoms

  • Depersonalisation is described as an overwhelming feeling of separation or disconnection from your body, thoughts, or emotions
  • DPD may make you feel like an outside observer of your own thoughts or body, often feeling a loss of control or as if you are ‘sleepwalking’ through life
  • You may be unable to accept your reflection in a mirror, or have out-of-body experiences, particularly during times of stress
  • Derealisation is more a feeling of detachment from your physical surroundings. You may see the world as somewhat surreal, foggy or in a dream
  • Associated issues: Depersonalisation and derealisation disorder often leads to inner turmoil which can in turn can lead to ‘comorbidity’ issues or conditions such as depression, anxiety issues, self-harm, low self-esteem, panic attacks, phobias. You may also experience physical symptoms, such as chest pain, blurry vision, nausea or tingling sensations (pins and needles)

Causes/Triggers

There can be a variety of triggers for DPD. Common causes include a major traumatic event, emotional or physical abuse or use of recreational drugs. However, the cause is not always so obvious.

Conventional Treatments

Depersonalisation Disorder is known to be a difficult condition to treat as it is so misunderstood.

Medication used for epilepsy or anxiety disorders can be successful. However, there can be unpleasant side effects with medication and while it may be effective in some cases, it does not work for all.

CBT (Cognitive Behaviour Therapy) can also be tried as a solution for DPD but again, the results of treatment vary.

rTMS at The Smart Clinics in London

Transcranial Magnetic Stimulation therapy treatment is available at Smart TMS, based at The Smart Clinics, Brompton Cross, London. Smart TMS was the first UK clinic to offer TMS treatment for DPD.

On the basis of research, we believe that rTMS could offer sufferers of DPD an alternative treatment option using transcranial magnetic stimulation to work directly on the associated areas of the brain. It would also offer the benefit of being a non-medication approach, avoiding potentially unpleasant side-effects associated with drugs.

To discuss this further, please contact us.

Patient Review

DPD Treatment with TMS

“I would like to take this opportunity to thank you for the care that I have received from [Dr Neal], Sylwia and the whole team at Smart TMS. You have all been fantastic and I would be grateful if you could pass on my regards.”

DPD Patient StoryTreatment at Smart TMS, London

Depersonalisation Disorder and TMS Treatment

Evidence, Research and Studies

Research Studies

In one study in New York (1), 12 patients with Depersonalisation Disorder were treated with rTMS for 3 weeks (15 sessions) over the right tempero-parietal junction with low frequency rTMS.  After 3 weeks 6 patients were classified as responding to the treatment, with at least a 50% reduction in their severity scores.  This group then continued for a further 3 weeks.  One dropped out and after a total of 6 weeks there was an average 68% reduction in the symptom scores of the 5 who continued the treatment.  There were no adverse side effects reported. It was concluded that rTMS treatment was safe and effective (Mantovani et al, 2011) . This research group are now conducting a randomized controlled study in New York using the same treatment protocol.

Another study (2) was conducted in the UK to determine which was the most effective part of the brain to treat with rTMS in Depersonalisation Disorder.  One group of patients was treated over the right tempero-parietal junction with one session of rTMS treatment and there was an average reduction in severity of 30%.  About a fifth experienced a transient drunk like feeling as a side effect.  The other group of patients was treated over the right frontal lobes with one session of rTMS and there was an average improvement of about 29% in their symptom severity scores.  About a third experienced transient twitching and jerking sensations as a side effect (Emma Louise Jay et al, 2014).

In a further study (3), 7 patients with medication-resistant DSM-IV DPD received up to 20 sessions of right-sided rTMS to the VLPFC for 10 weeks.  Stimulation was delivered at 110% of resting motor threshold. A session consisted of 1Hz repetitive TMS for 15min. The primary outcome measure was reduction in depersonalization symptoms on the Cambridge Depersonalization Scale (CDS). Secondary outcomes included scores on the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI). 20 sessions of rTMS treatment to right VLPFC significantly reduced scores on the CDS by on average 44% (range 2-83.5%). Two patients could be classified as “full responders”, four as “partial” and one a non-responder. Response usually occurred within the first 6 sessions. There were no significant adverse events (Jay et al, 2016).

If you wish to discuss the treatment of Depersonalisation Disorder with rTMS in more detail please contact our team at info@smartrtms.co.uk.

References

  • (1) Mantovani et al (2011) Temporo-parietal junction stimulation in the treatment of depersonalization disorder. Psychiatry Res. 30;186(1):138-40.
  • (2) Jay E-L et al (2014). Testing a Neurobiological Model of Depersonalization Disorder Using Repetitive Transcranial Magnetic Stimulation. Brain Stimulation, 7 (2), 252–259.
  • (3) Jay et al (2016) Ventrolateral prefrontal cortex repetitive transcranial magnetic stimulation in the treatment of depersonalization disorder: A consecutive case series. Psychiatry Res. 13;240:118-122.

Depersonalisation Disorder Self Help Forum

The Depersonalisation Disorder self-help forum www.dpselfhelp.com  is an online community for those suffering from Depersonalisation and Derealisation.  The forum offers support and help via a forum for the DPD community, where experiences, problems and ideas are shared with others who share a personal interest in DPD.

The treatment for DPD at Smart TMS is discussed in particular here: www.dpselfhelp.com TMS discussion

Read Forum Post on rTMS Treatment for DPD

Senior DPSelfhelp.com Member and King Moderator, King Elliot, says:

“Treatment of DP with TMS requires a completely different protocol to the treatment of depression or other disorders. Previously, no public TMS clinic would target the specific and unusual sites (i.e. the right ventrolateral prefrontal cortex and right temporoparietal junction) that are most effective for DP. That’s no longer the case.

“After a long correspondence with Dr Neal, the psychiatrist running the SmartTMS clinic in London, I convinced him to open his clinic to DP sufferers. Now, he is accepting applications from DP patients.

“He might be happier to treat you if you tell him that you came from me. He appreciates my extensive knowledge of TMS and DP literature. Unlike other professionals, Dr Neal actually likes me. :P

“I’m a big fan of Dr Neal. He went above and beyond the call of duty to help me. He put a huge amount of effort into making sure he read and understood the DP research. He was the opposite of patronising and treated me like a colleague. He was knowledgeable and when he wasn’t, he made sure he went away and became knowledgeable (like any good psychiatrist should yet so few do!). His clinic is also offering TMS at a very reasonable price. TMS is never cheap but the aggregate response rate in clinical trials so far has been over 60% so you’re paying for a treatment with very good odds. You will be expected to sign a disclaimer saying that you acknowledge that this is a completely experimental, off-label treatment but that’s a small compromise in my books.

“Hope this helps you, my fellow Brits!”

See www.dpselfhelp.com TMS discussion for latest discussion/comments.