# rTMS targets for depersonalisation -VLPFC and DLPFC. These structures role in suppressing of emotions.



## 35467 (Dec 31, 2010)

I am planing to try rTMS for my depersonalisation. I have read all the publications in relation to DP and what people have written on the internet of their experiences.

I have the impression that temporoparietal junction (TPJ) that the early trails targeted might not be effective for most. Some har responded but most have not.

At the depersonalisation unit they have tried to repress the overactivity in the ventrolateral prefrontal cortex (VLPFC) with rTMS that should suppress emotions. 5. of 6 patients had a response, The TMS clinic I have corresponded with, do not take the structure in DP.

They inhibit the right dorsolateral prefrontal cortex (DLPFC) and adding a stimulation the left dorsolateral prefrontal cortex (DLPFC) and might add the TPJ if there is no response.It might take uptil 3.weeks with daily rTMS to try that. They have tried 9.patients and 4 have responded. Some of those who did´t responded had 5.sesssions of inhibition of the right dorsolateral prefrontal cortex (DLPFC). Their response rate would be higher if they included the ventrolateral prefrontal cortex (VLPFC) as it is like to be the most potent in its ability suppress emotions.

Money and time is a big factor in rTMS and why so few have tried and many only take a few session before they drop out. Many clinics only work with one area,- TPJ.

In relation to this I came across a publication from 2018 about right dorsolateral prefrontal cortex (DLPFC) and dorsolateral prefrontal cortex (DLPFC) ability to suppress emotions in relation to social rejection/social pain/ trauma. That fits with the theory behind depersonalisation that there is a switch in the brain that can shot it down in social stress where escape is not an option and cut of to the world and emotions. The switch might have two locations that can do that, -and not one.

I will contact another rTMS clinic in Europe that treats a number of states "off-label" but not DP. They might not know of it. There are some professors in psychiatry behind it. I will ask them if they are willing to try both locations. They might be interested in getting some experience with this disorder.

The publication I am taking about is the one and it says about these two structures of the brain;

Meta-analyses and systematic review of neuroimaging studies have indicated that both dorsolateral prefrontal cortex (DLPFC) and ventrolateral prefrontal cortex (VLPFC) are core regions involved in emotional regulation (<a>Buhle et al., 2014</a>; <a>Kohn et al., 2014</a>), especially in down-regulation of negative emotions (<a>Zilverstand et al., 2017</a>). In the context of social exclusion, two brain regions, the ventral anterior cingulate cortex (VACC) and VLPFC, have been implicated in emotional regulation of social pain (<a>Riva and Eck, 2016</a>). VACC response has not been consistently reported to social exclusion; with studies variously suggesting either decreased, unchanged (<a>Somerville et al., 2006</a>) or increased activity (<a>Cristofori et al., 2013</a>). In contrast, neuroimaging studies have provided convergent evidence that the VLPFC, especially the right VLPFC (rVLPFC), shows increased activity in response to social exclusion and plays a regulatory or inhibitory role, thus reducing the social pain (<a>Eisenberger et al., 2003</a>; <a>Onoda et al., 2010</a>). For instance, rVLPFC activity has been found to be negatively correlated with self-reported distress when participants are faced with social exclusion, suggesting that this region plays a key role in reducing social pain (<a>Eisenberger et al., 2003</a>; <a>Masten et al., 2009</a>).

https://academic.oup.com/scan/article/13/4/357/4956232


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## Messirocks (May 29, 2019)

Kindly share your experience


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## 35467 (Dec 31, 2010)

I will. My point is that most people who has tried rTMS has not really tried those structures that is central for the disorder. Many has tried a protocol for depression or TPJ. There is been some responses to inhibition of DLPFC (4 of 9 has responded in a clinic in the Nederlands) or VLPFC(90% with 45% a reduction on average -2 of 6 became asymptomatic, 1 didn't respond at all) .VLPFC is the most potent inhibitor of emotions of the two. There has never been a trail where both structures has been exposed to an inhibition at the same time but both structures are repressors of negative emotion to social exclusion, pain/trauma. I think that more will respond to that and the reduction will be more significant if both are inhibited. I will try to get some clinics in Europe to make an inhibition of both of them. I am writing to one of them but my impression is they don't know of depersonalisation disorder so i have to make a synopsis for the disorder.


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## Messirocks (May 29, 2019)

You try and show the way to everyone


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## Messirocks (May 29, 2019)

Goodluck


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## lifegoson (Sep 14, 2009)

I've been suffering from unrelenting, chronic depersonalization for 30 years. I recently came across information about a clinical trial conducted by Columbia University in 2017 using TMS to treat depersonalization. http://www.brainstimulation.columbia.edu/research/clinical/dpd.html; http://www.brainstimulation.columbia.edu/staff/bio_mantovani.html

After reading many articles about TMS for treatment I am hopeful about a cure - for the first time. I cannot find the research paper for this Columbia University clinical trial yet but previous studies sound promising. https://clinicaltrials.gov/ct2/show/NCT02256085

https://www.ncbi.nlm.nih.gov/pubmed/28291040

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3968882/

I'm speaking with the program director for the clinical trial at Columbia University tomorrow about locating a TMS treatment facility in New York that has helped people DP. I'll update this forum with whatever I find.


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## lifegoson (Sep 14, 2009)

Where are you going for treatment?


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## Messirocks (May 29, 2019)

Plz update thank you


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## 35467 (Dec 31, 2010)

lifegoson said:


> Where are you going for treatment?


It is in a country in southern Europe. I have a dual citizenship there as my father come from there. Because they likely don't know about DP I have to write about the disorder. The medical chef of the rTMS chain is a prof. in psychiatry who have done several publication in the use of rTMS. There is some lectures with him on youtube about rTMS and addiction. He speaks english. I could get rTMS in the Nederlands or UK. But they don't use rTMS at the right ventrolateral prefrontal cortex (rVLPFC). It is difficult for most rTMS clinics to locate it and that is why almost all who have tried rTMS has never had taken that area that is the prime suspect in DP. To locate the area you often have the CT-scan of surface the brain. You shall have a software programme and a special setup in the clinic . With that you can locate precisely rVLPFC.The rTMS clinic I am writing to have that equipment can I see from videos and photos. They others don't have that. If they take me in, I respond and they say ok to more patients with depersonalisation I will say who they are and they will know that they will be contacted by english speakers with DP.


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## Messirocks (May 29, 2019)

Good idea plz do it fast


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## Messirocks (May 29, 2019)

Did u try


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## Messirocks (May 29, 2019)

Did u try it mayer-gross


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## 35467 (Dec 31, 2010)

Messirocks said:


> Did u try it mayer-gross


 I write that I am in a process of writing to them in a foreign county and then you ask how it goes almost the same how it goes. Are you for real? Do you really think that i would end up in a foreign country within a few days?Patients in that country likely have to wait for several weeks to come into treatment.I write that they don't know about DP and i have to write to them about the disorder. That will be finish today. They then likely also have to read up the material for the disorder and that might take some weeks. So, if they take me in it might be in the late July or the beginning of august. I post updates when it is relevant. Not, when you are asking your stupid quistions or send me personal PM.


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## Messirocks (May 29, 2019)

Calm


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## Dark12345 (Feb 6, 2020)

Did you try it Mayer-Gross?


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