Depersonalization/Derealization Disorder

Tovani does not treat this with ketamine

This page is here for honesty and completeness. Ketamine is not an appropriate treatment for Depersonalization/Derealization Disorder, and in some cases it is contraindicated. Below is what the condition is and the treatments that genuinely help — and where, if at all, ketamine has any narrow role (usually only for a separate co-occurring depression). If you’re in crisis, call or text 988.

The short version

●Depersonalization/derealization disorder (DPDR) is persistent or recurrent detachment from one's own self (depersonalization) or surroundings (derealization), while reality testing stays intact.
●It is distressing precisely because it is a chronic, unwanted dissociative state — a feeling of unreality, of watching yourself from outside, of the world seeming foggy or dreamlike.
●Ketamine reliably induces dissociation, depersonalization, and derealization as acute effects¹ — which is the opposite of what someone with DPDR wants, and a reason for caution.
●There is no established role for ketamine in DPDR, and inducing a dissociative state could be distressing or counter-therapeutic for these patients.
●Evidence-based care focuses on psychotherapy and treating co-occurring anxiety or depression; lamotrigine has limited supporting evidence.² ³
●Tovani does not treat DPDR, and a strong dissociative response to ketamine is a reason at-home treatment may not be appropriate. This page explains why.

Clinical definition

Depersonalization/derealization disorder is a dissociative disorder defined by persistent or recurrent experiences of depersonalization (feelings of unreality, detachment, or being an outside observer of one's thoughts, feelings, body, or actions) and/or derealization (experiences of unreality or detachment with respect to surroundings — people or objects seeming unreal, dreamlike, foggy, or visually distorted). Crucially, reality testing remains intact: the person knows the experiences are subjective, distinguishing DPDR from psychosis. The symptoms cause clinically significant distress or impairment and are not better explained by substances, another mental disorder, or a medical condition. It frequently co-occurs with anxiety and depression and is often triggered or worsened by stress.

How it differs from related conditions

vs. Generalized anxiety disorder

Anxiety commonly co-occurs with and triggers depersonalization, but DPDR's defining feature is the persistent dissociative detachment itself.

vs. Dissociative identity disorder

A more complex, trauma-rooted dissociative disorder with distinct identity states and memory gaps; DPDR involves detachment without those identity disruptions.

vs. PTSD

PTSD has a dissociative subtype that includes depersonalization/derealization; DPDR is the disorder when dissociation is the primary, standalone problem.

vs. Schizophrenia

In DPDR, reality testing is preserved — the person knows the experiences aren't real — which separates it from psychosis.

First-line treatments

Psychotherapy

Psychoeducation, grounding techniques, and cognitive and psychodynamic approaches that reduce the threat appraisal and avoidance maintaining the dissociation.

Treating co-occurring anxiety/depression

Because anxiety and depression frequently drive or worsen DPDR, treating them (e.g., with SSRIs and therapy) often reduces the dissociation.

Stress and trigger management

Identifying and reducing stressors, sleep deprivation, and substances (including cannabis) that precipitate episodes.

Lamotrigine (selected cases)

Has limited supporting evidence, mainly as an add-on; not a reliable monotherapy.

When standard treatments fail

When DPDR persists, care intensifies the psychotherapy (trauma-informed where relevant), optimizes treatment of co-occurring anxiety and depression, and may trial adjuncts such as lamotrigine that have limited evidence. Notably, the escalation pathway does not include dissociative agents like ketamine — introducing more dissociation runs counter to the goal of treatment.

Where ketamine fits

This is a case where ketamine's mechanism is the problem rather than the solution. Ketamine reliably produces dissociation, depersonalization, and derealization as acute effects — these are core to the ketamine experience and were characterized in classic human studies.¹ For someone whose primary suffering is a chronic, unwanted dissociative state, deliberately inducing more dissociation is at best counter-therapeutic and at worst distressing or destabilizing. There is no established evidence base for ketamine in DPDR, and the evidence-based approach is psychotherapy plus treating co-occurring anxiety and depression, with lamotrigine as a limited adjunct.² ³ For these reasons ketamine is not appropriate here.

Where this fits with Tovani

Tovani does not treat depersonalization/derealization disorder. Beyond the lack of evidence, ketamine's dissociative effect is specifically the wrong direction for someone whose core problem is unwanted dissociation. More broadly, a strong or distressing dissociative reaction to ketamine is one of the experiences our screening and preparation watch for in any patient. The right care for DPDR is psychotherapy and treatment of any co-occurring anxiety or depression — and we'd point you there.

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Frequently asked

Could ketamine help my depersonalization?

No — and it could make things harder. Ketamine reliably causes dissociation, depersonalization, and derealization as acute effects. For someone whose core problem is an unwanted chronic dissociative state, deliberately inducing more of it is counter-therapeutic. There's no evidence base for ketamine in DPDR.

What actually treats depersonalization/derealization?

Psychotherapy — psychoeducation, grounding, and cognitive or psychodynamic work — plus treating any co-occurring anxiety or depression, which often drive the dissociation. Lamotrigine has limited supporting evidence as an add-on. Reducing stress, poor sleep, and cannabis helps too.

Is depersonalization a form of psychosis?

No. In DPDR, reality testing stays intact — you know the experiences are subjective and not literally real. That preserved insight is exactly what separates it from psychosis, and it's an important distinction for getting the right treatment.

Does Tovani treat this?

No. Ketamine's dissociative effect is the wrong tool for a disorder of unwanted dissociation, and there's no evidence for it here. The right care is psychotherapy and treatment of co-occurring anxiety or depression, and we'd point you to that rather than offer something that could worsen the symptom.

References

Krystal JH et al. 1994, Archives of General Psychiatry — Characterized subanesthetic ketamine's acute dissociative, depersonalization, and derealization effects in humans. (PMID 8122957)
Sierra M & Phillips ML 2003, Journal of Psychopharmacology — Placebo-controlled crossover trial of lamotrigine in depersonalization disorder. (PMID 12680746)
Sierra M 2008, Expert Review of Neurotherapeutics — Review of pharmacological approaches to depersonalization disorder. (PMID 18088198)

Last reviewed by Dr. Ben Soffer, DO on June 2, 2026. This page is educational and not a substitute for clinical evaluation. A physician determines whether ketamine therapy is appropriate for your specific situation.