BackgroundDepersonalisation-derealisation disorder (DPRD) is a distressing and impairing
condition with a pathophysiology that is not well understood. Nevertheless, given
the growing interest in its pathogenesis, and the publication of a number of
treatment trials, a systematic review of randomised controlled pharmacotherapy and
psychotherapy trials is timely.MethodsA systematic search of articles on DPRD published from January 1980 to August
2012, using Cochrane methods, was conducted. All randomised controlled trials
(RCTs) of pharmacotherapy, psychotherapy, somatic interventions and a blend of
these modalities for the treatment of depersonalisation disorder were included in
the review. Searches were carried out on multiple databases. The bibliographies of
all identified trials were checked for additional studies and authors were
contacted for published trials. No unpublished trials were found and no
restrictions were placed on language and setting. Data extraction sheets were
further designed to enter specified data from each trial and risk of bias
information was identified. PRISMA guidelines were also followed to ensure that
our methodology and reporting were comprehensive. Of the unique 1296 papers that
were retrieved, four studies met the inclusion criteria and were reviewed.ResultsFour RCTs (all within the duration of 12 weeks or less) met study criteria and
were included (180 participants; age range 18–65 years). The four RCTs included
two lamotrigine studies, one fluoxetine study and one biofeedback study. Evidence
for the treatment efficacy of lamotrigine was found in one study (Cambridge
Dissociation Scale, CDC: p < 0.001) with no evidence of effect for lamotrigine
in the second study (CDS: p = 0.61 or Present State Examination: p = 0.17).
Fluoxetine and biofeedback were not more efficacious than the control condition,
although there was a trend for fluoxetine to demonstrate greater efficacy in those
with comorbid anxiety disorder. The four studies had 'low' or 'unclear' risk of
bias.ConclusionThe limited data from randomised controlled trials on the pharmacotherapy and
psychotherapy of DPRD demonstrates inconsistent evidence for the efficacy of
lamotrigine, and no efficacy for other interventions. Additional research on this
disorder is needed.