Treatment of depersonalization/derealization disorder

DDD: depersonalization/derealization disorder; CBT: cognitive-behavioral therapy; SNRI: serotonin-norepinephrine reuptake inhibitor; SSRI: selective serotonin reuptake inhibitor; TMS: transcranial magnetic stimulation.

* Refer to inset for choosing psychotherapy for treatment of DDD. Refer to UpToDate content for further discussion of treatment of DDD with psychotherapy.

¶ We typically use an SSRI or SNRI as treatment. Refer to UpToDate content for medication treatment of co-occurring anxiety or depression including choice of medication, titration, and trial length.

Δ We monitor for treatment response at each visit. Refer to UpToDate content for discussion of monitoring symptoms using clinical rating scales. We consider response to treatment by an improvement in dissociative symptoms and an improved sense of resilience to triggers.

◊ Refer to UpToDate content for discussion of the use of lamotrigine including dose, titration, side effects and other precautions in the treatment of DDD.

§ Refer to UpToDate content for discussion of treatment duration in those with an adequate response to treatment.

¥ Limited data guide further treatment of DDD. Our choice of treatment is based on patient preference and treatment availability.

‡ Longer term psychotherapy is typically measured in months to years. Refer to UpToDate content for discussion of longer term psychotherapy in the treatment of DDD.

† Hypnosis is typically provided over three to five sessions. Refer to UpToDate content for further discussion of hypnosis.

** Refer to UpToDate content for discussion of dose, titration, side effects, and other warnings in using stimulant medications or second-generation antipsychotics in the treatment of DDD.

¶¶ Refer to UpToDate content for discussion of dose, titration, and side effects related to treatment with clomipramine or naltrexone.