Medicines for Depersonalisation-derealisation

What it is

Depersonalisation and derealisation describe experiences of feeling detached from oneself or one's surroundings. In depersonalisation, a person feels detached from themselves — as if they are observing themselves from outside, or that their body, thoughts, feelings or actions are not quite their own, or feel unreal or robotic. In derealisation, the world around them feels unreal, dreamlike, foggy, or as if seen through glass, and people or surroundings may seem distant or lifeless. Importantly, during these experiences, the person knows that this is a feeling and that things are not actually unreal (their sense of reality is intact) — which distinguishes it from more serious conditions. Brief experiences of depersonalisation or derealisation are very common and can happen to many people, especially when tired, stressed, anxious, or during or after a frightening event, and are usually harmless and pass. However, in some people these experiences become frequent, persistent and distressing (depersonalisation-derealisation disorder), significantly affecting wellbeing. They are often linked to anxiety, stress, trauma, tiredness, and sometimes other conditions or substances. Although the experiences can be frightening (people sometimes fear they are "going mad" or losing control), it is reassuring that they are not dangerous and do not mean this, and that they are treatable.

How it is treated

For brief, occasional experiences, reassurance is usually all that is needed — understanding that depersonalisation and derealisation are common, harmless experiences, often related to tiredness, stress or anxiety, and that they pass, which itself reduces the fear that can worsen them. Where the experiences are frequent, persistent and distressing, treatment focuses on the underlying factors and the experiences themselves. Because they are so often linked to anxiety, stress and sometimes past trauma, addressing these is central: psychological therapy, particularly cognitive behavioural therapy (sometimes specifically adapted for depersonalisation), helps by addressing the anxiety and the way a person responds to and interprets the experiences (as fearful monitoring of the symptoms tends to maintain them), and by developing grounding and coping techniques. Treating any coexisting anxiety, depression, or the effects of trauma is important, and medication is sometimes used for these. Reducing contributing factors — such as stress, poor sleep, and, where relevant, cannabis or other substances that can trigger these experiences — helps. Grounding techniques (reconnecting with the senses and the present moment) can help during episodes. The reassuring message is that depersonalisation and derealisation, though they can be very frightening, are not dangerous and do not mean a person is losing their mind, that brief experiences are common and harmless, and that persistent, distressing forms are treatable — particularly by addressing anxiety and stress and through therapy.