Treatment of Depersonalization Disorder With Repetitive Transcranial Magnetic Stimulation

High frequency repetitive transcranial magnetic stimulation (rTMS) was approved by the US Food and Drug Administration in 2008 to treat major depressive disorder in those who did not respond to at least 1 antidepressant trial. Previous studies have shown that both high frequency rTMS to the left dorsolateral prefrontal cortex (DLPFC) and low frequency rTMS to the right DLPFC have antidepressant efficacy in treatment-resistant depression. Although rTMS has been widely used in the treatment of depression, very few studies of rTMS in patients with depersonalization disorder (DPD) have been published so far. DPD involves persistent or recurrent experiences of unreality and feelings of detachment causing distress or functional impairment while insight remains intact. The prevalence of DPD is approximately 1% to 2%. Studies of the pharmacological treatment of DPD are limited, and medications have proven to be of limited benefit. We present the case of a 30-year-old man with major depressive disorder and DPD who did not respond to pharmacotherapy. After the patient was treated with low frequency rTMS to the right DLPFC followed by high frequency rTMS to the left DLPFC, there was a significant reduction in his depersonalization symptoms. Given its effectiveness in our patient, the use of both low frequency rTMS to the right DLPFC and high frequency rTMS to the left DLPFC for treatment of DPD should be further explored.