Treatment of depersonalization disorder with clomipramine

Background: Although there is a dire paucity of data on the pharmacologic treatment of depersonalization disorder, there have been a few reports in the literature suggesting that selective serotonin reuptake inhibitors may be of therapeutic benefit. In this study, we undertook to evaluate the efficacy of the potent serotonin reuptake inhibitor clomipramine in treating depersonalization. Methods: Eight subjects with DSM-III-R depersonalization disorder were entered into a double-blind crossover trial consisting of 8 weeks desipramine and 8 weeks clomipramine. Due to the very small size of the trial findings are presented descriptively. Results: Of 7 subjects who entered the clomipramine trial, two showed significant improvement in depersonalization. Three subjects dropped out early, unable to tolerate adverse effects. Of 6 subjects who entered the desipramine trial, 1 showed significant improvement in depersonalization. One clomipramine responder was subsequently followed in open maintenance treatment with clomipramine for 4 years, and her depersonalization symptoms remained in almost complete remission, with relapses upon each attempt to taper off or switch medication. Conclusions: Clomipramine may be a promising pharmacologic treatment for primary depersonalization disorder and warrants further investigation.