Options for treating Depersonalization Anxiety Disorder

[Whiteheart]

Hey everyone, been a long time member but haven't posted much.
My brother has developed Depersonalization anxiety disorder over the past few years. He has implemented cyproheptadine the past few months, using it situationally when he could feel an anxiety attack encroaching. He used between 1 and 3mg roughly. He said it would take away the conscious feeling of anxiety, but he could still feel his body "freaking out" and detaching from him. He had hoped that the cyproheptadine would help his anxiety attacks slowly cease to arise or at least lessen their frequency.

His condition has recently worsened after he decided to consult with a behavioral therapist, of whoms methods included having him spin in a circle until it triggered an attack. Now he cannot breathe heavily or turn his head too quickly for fear of having subsequent attacks.
Would progesterone or a prog/dhea mix be a next good step to try? I believe it would calm the nervous system. I personally have used prog on and off for many years so I can attest to its calming effects.
He cannot eat very often (about once a day) for fear of it triggering an attack.
The person he has consulted with has now simply reverted to offering to prescribe SSRI's, so clearly that path is useless. He is trying to surmise how to proceed helping himself.
Any ideas or insights would be greatly appreciated

 

[alainchalamet]

I don't really want to advice a drug, nor have I ever tried it, but maybe look into Phenibut?

 

[redsun]

Hey everyone, been a long time member but haven't posted much.
My brother has developed Depersonalization anxiety disorder over the past few years. He has implemented cyproheptadine the past few months, using it situationally when he could feel an anxiety attack encroaching. He used between 1 and 3mg roughly. He said it would take away the conscious feeling of anxiety, but he could still feel his body "freaking out" and detaching from him. He had hoped that the cyproheptadine would help his anxiety attacks slowly cease to arise or at least lessen their frequency.

His condition has recently worsened after he decided to consult with a behavioral therapist, of whoms methods included having him spin in a circle until it triggered an attack. Now he cannot breathe heavily or turn his head too quickly for fear of having subsequent attacks.
Would progesterone or a prog/dhea mix be a next good step to try? I believe it would calm the nervous system. I personally have used prog on and off for many years so I can attest to its calming effects.
He cannot eat very often (about once a day) for fear of it triggering an attack.
The person he has consulted with has now simply reverted to offering to prescribe SSRI's, so clearly that path is useless. He is trying to surmise how to proceed helping himself.
Any ideas or insights would be greatly appreciated

There is no sense in giving hormones that are not directly going to help it. Depersonalization is hypothesized to be related to opioids, glutamate/ NMDA overactivation, serotonin (5HT2C activation). You can try opioid antagonists, reducing serotonin. Zinc may help antagonize NMDA and reduce opioid binding to receptors. Zinc is generally also helpful for anxiety.

 

[Whiteheart]

There is no sense in giving hormones that are not directly going to help it. Depersonalization is hypothesized to be related to opioids, glutamate/ NMDA overactivation, serotonin (5HT2C activation). You can try opioid antagonists, reducing serotonin. Zinc may help antagonize NMDA and reduce opioid binding to receptors. Zinc is generally also helpful for anxiety.

Cyproheptadine was first implemented as a way to lower serotonin. Perhaps the 1-3mg dosage was not high enough to have the desired effect.
The condition was indeed brought on years ago by cannabis use, as it was used for self medication during a rather turbulent time in life.
Will look more into zinc, thank you. I have recently suggested he incorporate oysters into his diet.

 

[Whiteheart]

I don't really want to advice a drug, nor have I ever tried it, but maybe look into Phenibut?

I have indeed heard of it, but will investigate it further. Thank you

 

[Pet Peeve]

Hi. I struggled with depersonalisation for years but I'm much better now. If you do some googling and reading you'll find that Ketamine can simulate what DP feels like, this is because it's an NMDA antagonist. Magnesium is another NMDA antagonist that gives me attacks after a while taking it. On the other side an example of an NMDA agonist that's easy to find is Glutamate, e.g. MSG.

NMDA receptor - Wikipedia

Evidence-based treatment for Depersonalisation-derealisation Disorder (DPRD)

 

[Whiteheart]

Hi. I struggled with depersonalisation for years but I'm much better now. If you do some googling and reading you'll find that Ketamine can simulate what DP feels like, this is because it's an NMDA antagonist. Magnesium is another NMDA antagonist that gives me attacks after a while taking it. On the other side an example of an NMDA agonist that's easy to find is Glutamate, e.g. MSG.

NMDA receptor - Wikipedia

Evidence-based treatment for Depersonalisation-derealisation Disorder (DPRD)

Thank you very much for the resources; I'll certainly check them out. Didn't know that about magnesium. I'm very glad you're doing well now

 

[Korven]

I believe DP/DR is a "mechanism" for the body to cope with (chronic) emotional stress and anxiety.

So anything that turns off the stress response should help, such as progesterone as you mentioned.

Though ideally he really wants to get to the root cause of what is making him fearful... What is it that is triggering the stress response? Something in his environment?Spending too much time ruminating on negative thoughts (possibly about the symptoms of depersonalization)?

For me personally, I only got better once I "fixed" my emotional and spiritual health. I had some pretty bad existential anxiety and I literally thought I was going out of my mind at times. It was like mental torture. Life just felt so overwhelming and like I wasn't in control of anything. Learning how to be okay with my anxiety and letting go of the need to have answer to every question in my head -- and instead surrendering to God/presence/stillness/whatever you wanna call it -- helped a ton.

Anxiety and DP/DR often becomes a vicious negative cycle because you're stressing out about the symptoms you're experiencing, causing more anxiety. I think an important step is to accept what is going on even if it's very painful, without trying to escape or make the unpleasant sensations go away. Paradoxically, things usually improve when you're at the stage where you're like "whatever, I'm fine with being all ****88 up."

Another thing that can be really helpful is to keep oneself occupied with something (does he have a job?) so that the mind has something to focus on. Otherwise all thought activity tends to be centred around one's illness and misery. You really don't want DP/DR to rule your life, you should go do the things you wanna do even if you feel really awful.

And yeah I think he needs to start eating 3 meals per day even if it's painful, calories are essential for dealing with stress.

 

[Whiteheart]

I believe DP/DR is a "mechanism" for the body to cope with (chronic) emotional stress and anxiety.

So anything that turns off the stress response should help, such as progesterone as you mentioned.

Though ideally he really wants to get to the root cause of what is making him fearful... What is it that is triggering the stress response? Something in his environment?Spending too much time ruminating on negative thoughts (possibly about the symptoms of depersonalization)?

For me personally, I only got better once I "fixed" my emotional and spiritual health. I had some pretty bad existential anxiety and I literally thought I was going out of my mind at times. It was like mental torture. Life just felt so overwhelming and like I wasn't in control of anything. Learning how to be okay with my anxiety and letting go of the need to have answer to every question in my head -- and instead surrendering to God/presence/stillness/whatever you wanna call it -- helped a ton.

Anxiety and DP/DR often becomes a vicious negative cycle because you're stressing out about the symptoms you're experiencing, causing more anxiety. I think an important step is to accept what is going on even if it's very painful, without trying to escape or make the unpleasant sensations go away. Paradoxically, things usually improve when you're at the stage where you're like "whatever, I'm fine with being all ****88 up."

Another thing that can be really helpful is to keep oneself occupied with something (does he have a job?) so that the mind has something to focus on. Otherwise all thought activity tends to be centred around one's illness and misery. You really don't want DP/DR to rule your life, you should go do the things you wanna do even if you feel really awful.

And yeah I think he needs to start eating 3 meals per day even if it's painful, calories are essential for dealing with stress.

Thanks Korven, I share many of the same sentiments. It is surely a culmination of a difficult life and environment. As I mentioned earlier, the Depersonalization first occured after cannabis use. The next time it was triggered was when he ate shrimp a few years later. After that, various foods seemed to trigger a response, then being in a car. Others started to accumulate.
He does have a job, but he often has episodes and must simply push through them or ask to have a break. He preoccupies himself with art, reading, music, playing guitar and other such activities.
He found pleasure in doing light excersize, until the therapist he was seeing suggested that he should spin in a circle till it brought on an anxiety attack so they could "work through it." As a result, too much exertion can bring on an attack.
There is certainly high serotonin and clearly signs of hypothyroidism, so adrenaline is chronically high.

A agree that a focus on peace and spiritual/emotional health is of great importance. I'll be sure to emphasize that. I'm very glad you've been able to grow and find peace spiritually. Thank you for your insight