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Glenn Yank, MD is a Psychiatrist located in Tennessee.


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Question:
Have there been any new advances in drugs or medications for dissociation or DID? My doctor is giving me atypical antipsychotic medication but it is not helping much. I have been doing much searching on the Internet for an answer but have had no success. I would be so grateful if you could help me. Thank you, Elleke

Answer:

At this time, there is no specific medication, of which I am aware, that directly affects the dissociative process. Most efforts to treat dissociation with medications attempt to decrease anxiety, which drives dissociation. People with dissociative disorders tend to dissociate more when they are feeling very anxious. From the psychodynamic perspective, dissociation is considered a defense against anxiety, which means that it is an automatic process that occurs to decrease the intensity of a person’s distress. Regardless of the theory one uses to explain it, what I observe in people with dissociative disorders is that they dissociate more when they are under a great deal of stress, and that medications that decrease their feelings of anxiety and stress may decrease, by a modest amount, how much they dissociate. However, these medications do not change the basic process of dissociation, so I would not call them “anti-dissociative.”

In addition, people who experience dissociation and DID often suffer other psychiatric syndromes for which there are more specific medication treatments, such as Post-Traumatic Stress Disorder (PTSD), and other Anxiety Disorders and Mood Disorders. More specifically, since dissociation was a mechanism used to handle the unbearable experiences of certain traumatic stresses (such as childhood sexual abuse), PTSD symptoms such as flashbacks, nightmares, emotional numbing, and hyper-arousal are often found in people who dissociate, and can be helped by medication treatments, although flashbacks are difficult to suppress with medications in my experience. I will elaborate, but confine this discussion to treatment of dissociation, anxiety, and core PTSD symptoms.

Many different classes of medication are used to treat anxiety, and similar feelings that get labelled as agitation and being “stressed out.” Drugs used for these purposes include benzodiazepines, buspirone, antihistamines, several kinds of antidepressants, a few anti-convulsants, and atypical antipsychotic drugs.

Benzodiazepine drugs (alprazolam, clonazepam, diazepam, lorazepam, oxazepam, chlorazepate, chlordiazepoxide, etc.), can decrease anxiety symptoms of tension, apprehensiveness, restlessness, “on-edge,” jitteriness, worry, shakiness, insomnia, etc. The use of benzodiazepine drugs is limited by several factors including side effects and risks of abuse of these drugs and developing dependence upon them. Side effects of these drugs can include sedation and memory impairment at higher doses. People tend to have very strong opinions about this class of drugs, both pro and con. In my opinion, they can be dangerous for people who are prone to become addicted to drugs or other addictive behaviors, and for people who have very strong dependency traits. On the other hand, benzodiazepines used responsibly can help people tolerate periods of severe stress. The only new developments with regard to this group of drugs are the release of Xanax XR, a once or twice per day form of aprazolam, and a form of clonazepam (Klonopin) that dissolves in the mouth and is supposed to get into the bloodstream a little faster than regular clonazepam.

Antidepressants are being used more frequently to treat a variety of anxiety symptoms and PTSD symptoms. Selective Serotonin Reuptake Inhibitor (SSRI) antidepressants have been shown to be helpful for a variety of PTSD symptoms. According to the study: Characterizing The Effects Of Sertraline In Post-Traumatic Stress Disorder. (Davidson JR, Landerman LR, Farfel GM, Clary CM. Psychol Med. 2002 May;32(4):661-70.)

Sertraline was superior to placebo on 15 of 17 symptoms, especially in the numbing and hyperarousal clusters. A strong effect was found on anger from week 1, which partly explained the subsequent effects of sertraline on other symptoms, some of which began to show significantly greater response to drug than to placebo at week 6 (emotional upset at reminders, anhedonia, detachment, numbness, hypervigilance) and week 10 (avoidance of activities, foreshortened future). CONCLUSIONS: Sertraline exercises a broad spectrum effect in PTSD. Effects are more apparent on the psychological rather than somatic symptoms of PTSD, with an early modulation of anger and, perhaps, other affects, preceding improvement in other symptoms.

These findings are representative of the effects of this group of drugs on PTSD symptoms. In addition, SSRI antidepressants and venlafaxine have been shown to helpful in Generalized Anxiety Disorder. Therefore, these drugs may be of benefit to people with dissociative symptoms, if they have a significant degree of anxiety, or depression.

Antihistamines are worthy of mention in that hydroxyzine (Atarax, Vistaril) can decrease anxiety somewhat, but does not cause the build up of tolerance and dependence, as do benzodiazepines. Some patients in my practice find it helpful. Another antihistamine, cyproheptadine (Periactin) appears to be able to decrease traumatic nightmares, and I have used this with several patients.

A few anticonvulsant drugs have been used to treat anxiety in specific syndromes. Gabapentin (Neurontin) has shown some promise for social anxiety. There is only very preliminary data about trials of valproate (Depakote) or tiagabine (Gabatril) in anxiety disorders, but the effects of these drugs on the brain chemical GABA (gamma amino butyric acid) and its receptors makes trials of anticonvulants for anxiety disorders reasonable. GABA is a neurotransmitter (a chemical that goes between brain cells) that tends to make cells less active, and these anticonvulsant drugs work on this chemical system to “calm” areas of the brain that are excited.

Atypical antipsychotic drugs can decrease agitation (physical restlessness) and can slow racing thoughts. They can also help people feel less anxious, and can make antidepressants work more effectively. They do not, however, make alters go away. I mention this because sometimes people with DID are given antipsychotic drugs because doctors mistake their alters for hallucinations. The experience of hearing an alter inside is different than the hallucinations that are part of other disorders such as schizophrenia and psychotic forms of depression and bipolar disorder. Atypical antipsychotic drugs are also helpful sometimes if people with dissociative disorder also have Bipolar Affective Disorder, as they have anti-manic properties. One new drug in this class has been introduced this year, which is Abilify. In my experience it has a relatively favorable side effect profile compared to other such drugs, in that sedation, weight gain, and movement disorders are not as frequent as with some other drugs in that group. I find that I have been using it more as the year goes on and I get more familiar with it.

Another group of drugs that deserves mention is a group called “alpha blockers.” These drugs are usually used for treating high blood pressure. They work on the autonomic nervous system, which is the part of the nervous system that controls arousal and the “fight or flight” response. Increased arousal is one of the core symptoms of PTSD. These drugs are worth knowing about because two of them, clonidine and Tenex, can suppress the exaggerated startle response that troubles some people who have PTSD, and another one, called Prazosin, is being studied in the Veterans Administration system for PTSD symptoms, more globally. As medicines for hypertension, their most common side effect is that they lower blood pressure.

I also want to briefly mention the drug lamotrigine (Lamictal). Lamotrigine is an anticonvulsant that is particularly useful for the depressive symptoms of Bipolar Disorder. It also appears to block some of the effects of drugs called dissociative anesthetics, such as ketamine (called Special K on the street). Dissociative anesthetics cause people to feel “spaced out,” unreal, and depersonalized. In some experimental models, lamotrigine can prevent this. Whether that will translate into decreasing dissociation that is a result of trauma is under study.

I fear that I have rambled in trying to answer your question, but what I wanted to convey is that there is no specific drug for dissociation or DID, but that sometimes medications can decrease anxiety that causes people to dissociate more, and that there are medications that can help with other symptoms that trouble people with dissociation or DID.

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Disclaimer: The information contained here is not intended nor implied to be a substitute for professional advice relative to your specific medical or mental health condition or question. ALWAYS seek the advice of your physician or other health provider for any questions you may have regarding your medical or mental health condition. Information provided here DOES NOT constitute a doctor-patient relationship between you and the column author.

© Copyright 2003-2005. All rights reserved. Contact: ShrinkTime Last edited: 07/19/03.