BLOG No. THIRTY FOUR

Welcome back to my blog on anxiety and depression. Today I want to discuss derealization and depersonalization. Though I do not see it a lot, I have seen it in a handful of patients. I bring it up because a lot of times, patients don’t bring it up. Both are frightening experiences, where people fear that they are going crazy. So, a lot of patients do not discuss it, unless they really trust you as a provider.

Derealization is the sense that the outside world is other than what you know it to be.

Patients can have an emotional disconnect with the world, or they feel that their surroundings are completely distorted. They can also be blurry or just two-dimensional. Sometimes the physical universe can be without color. And this distortion of the universe could happen for a matter of seconds, minutes, or hours. It could also happen just once a month or could also happen multiple times during the day.

Depersonalization is extremely similar, however it relates to the altered perceptions of one’s self.

Patient sometimes say they feel like a robot, and parts of their body, especially the arms and legs, appear distorted, larger or smaller than they really are. There also can be emotional or physical numbness. The patient may reflect on pleasant memories, such as the birth of a child or a wedding day, but these memories lack emotion. And sometimes when a patient focuses on a memory, they may suddenly feel that those memories are not their own, but belong to someone else.

I think it goes without saying, that these experiences can be frightening, especially when it happens numerous times a day! So, knowing that this topic is quite heavy, maybe it’s time for a joke break.

My good friend scratched his eye at work and had to see the eye doctor. She patched it, and then he stopped by my house to watch Pirates of the Caribbean. He had a difficult time enjoying the movie as he remarked that he had no Depp perception.

Depersonalization and derealization come about due to extreme anxiety. A lot of times these patients have experience something traumatic in their lives. But not everyone who experiences trauma suffers from derealization and depersonalization, and not everyone who has depersonalization and derealization has experienced something traumatic.

So why do these two frightening experiences happen? Well no one knows for sure, but I have an idea, and have successfully tested my theory numerous times. When I first encountered depersonalization and derealization, I turned to research that had been done on MDMA. (No, this is not the pay-per-view kick-boxers!) MDMA is Ecstasy. Ecstasy, of course, is taken by a lot of young people at concerts and parties to chill out.

But how does MDMA work? Well at low doses it stimulate serotonin 1B receptors, which give a feeling of relaxation and social bonding. But when the dosage increases, it begins to stimulate levels of dopamine. At first, levels of D1 dopamine sensed by the nucleus accumbens bring pleasure. We learned this in a previous blog on addiction. But then, other types of dopamine (including D2) go up as patients increase the dose, causing the patient to experience paranoia, anxiety and—wait for it—perceptual changes. Could D2 dopamine be responsible for derealization and depersonalization?

I began treating these frightening experiences with D2 lowering medications and can report to you that all of those patients, not some, but all, are doing well. Although each patient’s experience of perceptual change was different, all got better.

Well, I was just called a racist for ordering a “white” wine. How insensitive of me! From now on I will ask to order a wine that is not red. Until next time, when we look at a case study of depersonalization and derealization, this is Dr. G saying, keep the faith!