Clinical Improvement Following Multimodal Treatment in Depersonalization-Derealization Disorder: A Case Report.
Qiyu Zheng, Yan Zhao, Sisi Zheng et al.
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Case in brief
A patient with depersonalization-derealization disorder presented with derealization, emotional blunting, poor memory, slowed reactions, and impaired attention. Assessment showed marked depersonalization-derealization symptoms (Cambridge Depersonalization Scale score 147), with HAMD-24 score 8, HAMA-14 score 5, and MATRICS Consensus Cognitive Battery composite T-score 49. Treatment was introduced sequentially, combining transcranial direct current stimulation with duloxetine and tandospirone, followed by duloxetine optimization and lamotrigine augmentation and titration. Clinical improvement was observed during follow-up, after which medications were gradually tapered with monitoring.
What made this case unusual
The report describes a monitored, sequential combination of brain stimulation and several medication adjustments, followed by gradual medication tapering, in a disorder for which established treatment evidence is limited.
Diagnostic / clinical pearl
In DPD, assess detachment symptoms alongside mood, anxiety, and cognitive measures; this case illustrates tracking clinical change during sequential, monitored treatment rather than attributing improvement to a single intervention.
Why it matters
The temporal association between multimodal treatment and improvement is hypothesis-generating, but a single case cannot establish which intervention contributed or support conclusions about efficacy.