Dissociative disorders unclear? Think ‘rainbows from pain blows’
Visual metaphor answers the question, “What’s ‘dissociated’ in dissociative disorders?”
Adjunctive medications
Few studies have addressed using psychopharmacologic interventions in the heterogeneous dissociative disorders. GABAA antagonism and 5-HT2a/2c agonism have induced psychotic and dissociative-like symptoms in healthy men,29 and alterations in enzymes such as catechol-O-methyltransferase (COMT) may explain individual vulnerability to trauma.30 Reports of dissociation related to ketamine31 and marijuana32 implicate other neurotransmitter systems in their etiology.
DID. Similar to guidelines for borderline personality disorder,33 guidelines for DID suggest using medications to treat the most prominent symptom clusters such as insomnia, affective instability, and posttraumatic intrusions.
Depersonalization disorder. Trials of fluoxetine and lamotrigine showed no benefit in depersonalization disorder.34,35 In an open trial of 14 patients, naloxone (mean 120 mg/d) reduced depersonalization symptoms by 30%, as measured by 3 validated scales.36
Related Resources
- International Society for the Study of Trauma and Dissociation. Site for professionals. www.isst-d.org
- National Alliance on Mental Illness (NAMI). Patient education on dissociative disorders. www.nami.org/Content/ContentGroups/Helpline1/Dissociative_Disorders.htm
- Fluoxetine • Prozac
- Lamotrigine • Lamictal
- Naloxone • Narcan
- Paroxetine • Paxil
Dr. MacDonald is a speaker for Eli Lilly and Company, Janssen, L.P., and Pfizer Inc.
