# Emotional numbness - what Is the best med? Help me please



## Rl90 (6 mo ago)

I miss my emotions and feelings... I miss feel the Life.
Anyone overcome emotional numbness?


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## leminaseri (Jul 1, 2020)

Rl90 said:


> I miss my emotions and feelings... I miss feel the Life.
> Anyone overcome emotional numbness?


no one i have seen on the internet with severe emotional numbness was recovered completely. i can just find statements like „..now im feeling them sometimes like a glimp..“ or „…my emotions are very superficial and they lack vividness..“

so i think if our brain decided to shut emotions off why ever as well, there need a deep understanding of how our brain did this in first place because this alteration of mind doesnt happen in 2 weeks. it is a repetitive process of maybe 4-5 years. i barely remwmber what i eaten yesterday how should i process my last 5 years?


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## Peter (Jun 25, 2018)

Unfortunately not much is known about how to treat emotional numbness or anhedonia irrespective of the diagnosis where it occurs. Although it's one of the most severe problems patients with mental disorders can face psychiatry largely ignored the problem.

Apart from drugs that may work for depersonalization disorder (e. g. lamotrigine, naltrexone, clomipramine, clonazepam) you might take a look into drugs which target the dopaminergic system. There is a huge range of these drugs, which differ in regards to how strong they are, which subcomponents of the dopaminergic system they target and which side-effects, withdrawal and tolerance problems they may cause. They include certain atypical antipsychotics (aripiprazole, amisulpride, cariprazine), irreversible monoamine oxidase inhibitors, stimulants and dopamine agonists (e. g. pramiprexole). They sometimes work, but probably not often.

In the context of treatment-resistant depression ketamine and psychedelics were reported to work for emotional numbness at least temporarily. However depersonalization disorder might be a different story. Some people with emotional numbness and depersonalization tried the experimental drugs NSI-189 and reported significant benefit from it, but doing that introduces a new level of risk.

You can go deep into the drug ride and it's probably the only realistic chance for relief for most, but you will face a high likelihood that it's a dead end like for most of us.


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## Rl90 (6 mo ago)

Peter said:


> Unfortunately not much is known about how to treat emotional numbness or anhedonia irrespective of the diagnosis where it occurs. Although it's one of the most severe problems patients with mental disorders can face psychiatry largely ignored the problem.
> 
> Apart from drugs that may work for depersonalization disorder (e. g. lamotrigine, naltrexone, clomipramine, clonazepam) you might take a look into drugs which target the dopaminergic system. There is a huge range of these drugs, which differ in regards to how strong they are, which subcomponents of the dopaminergic system they target and which side-effects, withdrawal and tolerance problems they may cause. They include certain atypical antipsychotics (aripiprazole, amisulpride, cariprazine), irreversible monoamine oxidase inhibitors, stimulants and dopamine agonists (e. g. pramiprexole). They sometimes work, but probably not often.
> 
> ...


😭😭😭 I don't want to live all my life with emotional numbness... It's the hell


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## Peter (Jun 25, 2018)

> I don't want to live all my life with emotional numbness... It's the hell


I know, we all do.

You could also try transcranial magnetic stimulation on regions associated with depersonalization if you find someone willing to offer this treatment for you and you are able to pay for it.


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## Rl90 (6 mo ago)

Peter said:


> I know, we all do.
> 
> You could also try transcranial magnetic stimulation on regions associated with depersonalization if you find someone willing to offer this treatment for you and you are able to pay for it.


Did you tried a lot of meds? Which ones?


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## 35467 (Dec 31, 2010)

I have tried rTMS at the location tried in depersonalization -the right VLPC and the right TPJ with neuronavigation from a MRI scan done at my brain. It didn't work for me and me impression is it does for very few. You need neuronavigation to replicate the trails to find the exact location. 95% of the rTMS providers don't have it. 
These trails are more or close to 10.years old, they are very small in size. The right VLPFC was only 9.patients with no follow up. When there is no follow up after the trail with testing and a conversation 1, 3 and 6.months after the trail there is a significant risk that placebo effect is very high or it all is placebo. Many feel slightly better as long they try something and therefor to see who it goes after is more important. Research into depersonalization is very underfunded as the condition have been unknown, mis-diagnosed or seen as very rare. This gives research that is exposed to economic priorities that also makes the risk that data can not be replicated very high than normal. The size of patients is low, no follow ups, no place groups e.c.t.

The basis for rTMS locations is based in tree things; 1) Brain imaging done in patients with depersonalization,- functional and structural 2) the basic research of how the brain regulates emotions 3) the brain stimulation technology available at that time and the technological limitations they have to change the emotional regulation of the brain. 
The brain imaging of those trials goes back to 20.years ago. The right VLPFC was chosen as it stood out and you could stimulate 30-40% of it with rTMS and the coils used and developed 20.years ago. Other locations in depersonalization have also been found abnormal like the dorso medial prefrontal cortex and the right orbito prefrontal cortex. A recent German structural scan found indication of the network with these two location and a indication of a strong obsessive compulsive component as being a part of the network along with a immobilisation response. The German researcher have recommend a trial to combining functional brain imaging and making provokations/stimulations with more advanced rTMS to detect and find those networks behind the condition. Since 2015 a coil that can go twice as deep have been developed and locations never tried and that was excluded as they were too deep at the time can now be stimulated and tested. 
We know much more about emotional regulation and networks since the "depersonalization research unit" and its New York research unit was active (after 2014) from depression, the dissociative sub-type of PTSD. Brain imaging have improved significantly since 2014. New sensors on the scanners, new software used, much faster computers to generate images. A Research scanner is typically of 3.tesla and as high as 7.tesla that have come out recently. Scanners used in research is not the same as those used in hospital. 95% of those used in hospitals are below 3.tesla. Typical 1.5 Tesla. The software and computers used are not the same as used in research and they are not powerful enough. Research and making such analysis can only be made a very limited research institutions. 

So, there is a huge gab in depersonalization research and interventions of nearly a decade. The data they found then will likely not replicate today and there are many more ways to intervene today than there was 10-20.years ago. Synchronized TMS in development for refractory depression is likely the most promising as it can normalize the brains oscillators and rhythm in depressed. Many with major depression have very high theta and alpha waves and you find a similar depersonalization. You can with synchronized TMS reset the brain and normalize those high theta and alpha waves so the brain becomes more synchronized and rhythmic. So, when trails done in depression and trail done in depersonalization could be be interesting and hopefully it could also become available and approved for clinical intervention.


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## Peter (Jun 25, 2018)

The results of the PERSONA trial will be very interesting, because not only do they target another area, but they also addressed all the shortcomings of the past clinical trials on TMS. Even the older clinical trials indicate that neuromodulation might have potential for treating depersonalization disorder and I agree that newer more sophisticated techniques could be required to unlock the full potential.

However this all won't help, because the clinical trials on depersonalization disorder won't be done. Just thank the psychiatrists who ignore depersonalization disorder and the sufferers who keep it this way, by proclaiming to the public the all people with depersonalization disorder recover by accepting the disorder.


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## Rl90 (6 mo ago)

Mayer-Gross said:


> I have tried rTMS at the location tried in depersonalization -the right VLPC and the right TPJ with neuronavigation from a MRI scan done at my brain. It didn't work for me and me impression is it does for very few. You need neuronavigation to replicate the trails to find the exact location. 95% of the rTMS providers don't have it.
> These trails are more or close to 10.years old, they are very small in size. The right VLPFC was only 9.patients with no follow up. When there is no follow up after the trail with testing and a conversation 1, 3 and 6.months after the trail there is a significant risk that placebo effect is very high or it all is placebo. Many feel slightly better as long they try something and therefor to see who it goes after is more important. Research into depersonalization is very underfunded as the condition have been unknown, mis-diagnosed or seen as very rare. This gives research that is exposed to economic priorities that also makes the risk that data can not be replicated very high than normal. The size of patients is low, no follow ups, no place groups e.c.t.
> 
> The basis for rTMS locations is based in tree things; 1) Brain imaging done in patients with depersonalization,- functional and structural 2) the basic research of how the brain regulates emotions 3) the brain stimulation technology available at that time and the technological limitations they have to change the emotional regulation of the brain.
> ...


What about meds?


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## 35467 (Dec 31, 2010)

There is no formel medical treatment approved for depersonalization but some get a benefit from a combination of a antidepressant in the SSRI or SNRI class with lamotrigine in the dose of 200-300.mg.








Lamotrigine as an add-on treatment for depersonalization disorder: a retrospective study of 32 cases - PubMed


The results of this trial suggest that a significant number of patients with DPD may respond to lamotrigine when combined with antidepressant medication. The results are sufficiently positive to prompt a larger controlled evaluation of lamotrigine as "add-on" treatment in DPD.




pubmed.ncbi.nlm.nih.gov


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## 35467 (Dec 31, 2010)

Peter said:


> The results of the PERSONA trial will be very interesting, because not only do they target another area, but they also addressed all the shortcomings of the past clinical trials on TMS. Even the older clinical trials indicate that neuromodulation might have potential for treating depersonalization disorder and I agree that newer more sophisticated techniques could be required to unlock the full potential.
> 
> However this all won't help, because the clinical trials on depersonalization disorder won't be done. Just thank the psychiatrists who ignore depersonalization disorder and the sufferers who keep it this way, by proclaiming to the public the all people with depersonalization disorder recover by accepting the disorder.


Research founding into psychiatry is very difficult to get. It is likely the area in medicine that gets the least founding. When cancer-research gets 750.dollars ,- psychiatry gets 1.dollar. So, 750.more money to cancer research than to psychiatry. In psychiatry there is a hierarchy of the disorders with schizophrenia, psychosis and depression at the top. Disorders that puts people in hospital is at the top. Depersonalization is low partly because it have been unknown until recently. 1/4 with depersonalization are very sick and gets depressed and in the other spectrum you can find people who can live with it but still with some low quality of life. 
But, there are small studies done the recent years in Japan, China, France, Germany, Italy, Schweiz besides the US and England. A decade ago it was only the US and England that came with publications. So, it is more known today as so many counties do some studies. They are aware of the condition.Getting private and public founding in scale to make 4-5.studies year in patient size that have high validity is difficult.

The research into synchronized TMS is about making an intervention that will work in many conditions where brain networks are disrupted. They also called in individualized or precision TMS because the stimulation and likely also the locations of the 3.coil will be based on a qEEG or a multi functional scan to map brain networks. Some the parameter will not be the same for 20.persons with the same condition. Locations and stimulation frequencies will likely vary from the individual to individual. So, you might not need to understand the condition to treat it. Depression is not understood and the mechanism on why many interventions work is not fully understood either. But, you can treat 80-85% of them who have it with the interventions. But, to test if Synchronized TMS will work in depersonalization can hopefully be done within the coming years.


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## Rl90 (6 mo ago)

Mayer-Gross said:


> There is no formel medical treatment approved for depersonalization but some get a benefit from a combination of a antidepressant in the SSRI or SNRI class with lamotrigine in the dose of 200-300.mg.
> 
> 
> 
> ...


Are you a py


Mayer-Gross said:


> There is no formel medical treatment approved for depersonalization but some get a benefit from a combination of a antidepressant in the SSRI or SNRI class with lamotrigine in the dose of 200-300.mg.
> 
> 
> 
> ...


Are you a physician?


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## 35467 (Dec 31, 2010)

No, but I have read everything into depersonalization. Have a BA in psychology though but it is not very useful when it comes to such kind of research. Most medical professionals and psychiatrists will not understand areas like emotional regulation of the brain, brain stimulation. It is a specialized field within psychiatry.

You can take a look at this 45.min webinar that have clips with people with depersonalization and conversation. Two former researchers at the former "Depersonalization research Unit", prof. Anthony David and psychologist, Elaine Hunter might address some of your questions.


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## Peter (Jun 25, 2018)

> Research founding into psychiatry is very difficult to get. It is likely the area in medicine that gets the least founding. When cancer-research gets 750.dollars ,- psychiatry gets 1.dollar. So, 750.more money to cancer research than to psychiatry. In psychiatry there is a hierarchy of the disorders with schizophrenia, psychosis and depression at the top. Disorders that puts people in hospital is at the top.


I know about these things since I'm unfortunately not new to this area. I even compared the number of publications for several mental disorder on Pubmed and confirmed to myself this way the hierarchy you are mentioning.



> But, there are small studies done the recent years in Japan, China, France, Germany, Italy, Schweiz besides the US and England. A decade ago it was only the US and England that came with publications. So, it is more known today as so many counties do some studies. They are aware of the condition.Getting private and public founding in scale to make 4-5.studies year in patient size that have high validity is difficult.


This is something where I disagree with you. Go to Pubmed, use "depersonalization[title] OR depersonalisation[title] OR derealization[title] OR derealisation[title]" as a search query and take a look at the "results by year" graph on the right. You will see that publications per year permanently increased starting at the 2000s, but there was no further growth in the last 20 years, while publication numbers for pretty much any other mental disorder were rising sharply and continue to do so. There are no signs that awareness of depersonalization disorder and research activity are significantly rising.



> Have a BA in psychology though but it is not very useful when it comes to such kind of research.


Throughout the last years I have been thinking occasionally about self-studying a bit of psychology to allow myself to better understand these things. So you would say that it probably doesn't really help that much, even if it was a bachelors degree?

This would also explain why almost all sufferers I met who claimed to study or have studied psychology were not any less clueless than the average suffer, but often much more arrogant (doesn't include you).



> You can take a look at this 45.min webinar that have clips with people with depersonalization and conversation. Two former researchers at the former "Depersonalization research Unit", prof. Anthony David and psychologist, Elaine Hunter might address some of your questions.


Recently I read the book "Life on Autopilot: A Guide to Living with Depersonalization Disorder" by Joe Perkins, which gives some insight into the opinions of Elaine Hunter, Anthony David and some other so-called professionals who concern themselves more or less with depersonalization by now. I would say that Sierra was likely the only smart person inside the Depersonalization Research Unit. Once he was gone, everything went to the dogs and this cannot only be explained by low funding, given the opinions of the likes of Elaine Hunter and Anthony David. For example Elaine Hunter is quoted by saying: _"Depersonalization is trying to be your friend."_ This is no joke!


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## 35467 (Dec 31, 2010)

You are likely right in it is not growing if you look at total publications over two decades. Until 2014 the "Depersonalization research unit" and it even smaller New York based unit had a monopoly on research. There was almost no publication from other countries. Some few from Italy and Germany. After 2014 after both the US and the English units closed down there have almost been nothing from those counties. The publications comes from counties that was not active when they existed. So, publications have declined in the UK and US but grown in other countries. There is also many intersting publications related to the dissociative subtype of PTSD done by Ruth Lanius. She comes out with 3-5.publications a year. There are some overlaps between the two conditions and it gives some ideas the direction research could take. 

I agree about Joe Perkins. He has a fascination and authority to "researchers" that I would find highly speculative. Most of them are female psychologists. I really don't think that soft interventions like cognitive therapy will have any effect when people have had it for some year. It seems to run chronic and stable in most if doesn't go away within the first few years. structural brain scans from Germany also indicate the brain becomes more "hard-wired" to the state with time. There is a need for some somatic intervention that works in 8-90% with at least a 50% reduction in symptoms within 4-6.weeks. More psychological approaches and softer interventions might also become more productive as a supplement to such an interventions. 

I had some comments to his latest video but was lectured by a stalker and troll who told me that I didn't have the right to put their authority into question as I was not a "researcher" as the brilliant psychologists Joe uses. So, I deleted it. Didn't want to wasted my time on an idiot with high self-esteem. I have meet one of them in Budapest in 2020 to a lecture she gave and I really can´t see any contribution she can come with. She is very philosophical and thinks depersonalization is related to obsession and we "just have to stop obsessing". That there is an obsessive component in the state have been known for nearly a 100.years and many findings point towards such a component plays a role.


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## Peter (Jun 25, 2018)

> I had some comments to his latest video but was lectured by a stalker and troll who told me that I didn't have the right to put their authority into question as I was not a "researcher" as the brilliant psychologists Joe uses. So, I deleted it.


So you were Dini Cini and responded to my longer comment? I could still see that you commented critically, because I got a notification, but when I went to the channel I could not see any of your comments. You should not have deleted your comments yourself, because this made me believe that Joe Perkins censored them away, because unfortunately nowadays censorship is rife in most depersonalization communities.

Perhaps this is a sign of the rigid british class structure.



> The publications comes from counties that was not active when they existed.


Okay, I give you that. However no new workgroups formed that consistently research depersonalization disorder.



> I agree about Joe Perkins. He has a fascination and authority to "researchers" that I would find highly speculative.


His book is basically argumentum ad verecundiam. He never thinks by himself except when it comes to tell stories about his own life. Like many books by sufferers it's more a book _with_ depersonalization and less _about_ depersonalization.



> I have meet one of them in Budapest in 2020 to a lecture she gave and I really can´t see any contribution she can come with. She is very philosophical and thinks depersonalization is related to obsession and we "just have to stop obsessing".


Looks like Anna Ciaunica is in real life even worse than on her papers.


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## 35467 (Dec 31, 2010)

I deleted it because it was a waste of time. A "Tony Soprano" made comments to all my 3.comments without I addressed him or replied to him. I tried to see if there was a blocking option and there was not. I decided to delete them because 95% don't have the background to understand most of it and when the only one reacting essentially said that those female psychologists are highly respected researchers and have authority makes everything I wrote invalid because I was not a researcher. I quoted a prof. in neuropsychology who is behind two structural brain scans done in Germany and she is highly critical in many aspect also about interventions to reverse it but also many aspects in findings and the patient size used (indications of small budgets). But, to this troll It was I who made subjective conclusions while I was only referring to others. Then he starts to come with his subjective analyses,- something he had accused me of and rejects everything.


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## Peter (Jun 25, 2018)

Mayer-Gross said:


> I deleted it because it was a waste of time. A "Tony Soprano" made comments to all my 3.comments without I addressed him or replied to him. I tried to see if there was a blocking option and there was not. I decided to delete them because 95% don't have the background to understand most of it and when the only one reacting essentially said that those female psychologists are highly respected researchers and have authority makes everything I wrote invalid because I was not a researcher. I quoted a prof. in neuropsychology who is behind two structural brain scans done in Germany and she is highly critical in many aspect also about interventions to reverse it but also many aspects in findings and the patient size used (indications of small budgets). But, to this troll It was I who made subjective conclusions while I was only referring to others. Then he starts to come with his subjective analyses,- something he had accused me of and rejects everything.


It's really a pity that you deleted your comments, because they sounded interesting and I wanted to read them. Please don't censor yourself away. They want to silence you and you should not do that yourself.


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