What Drugs Can Cause Derealization?

According to the DSM-5, derealization can be triggered by substance abuse, including hallucinogens, ketamine, and cannabis. This dissociative symptom can also manifest as a side effect of various prescription drugs or during withdrawal, leading many to question, 'What drugs can cause derealization?'.

Quick Summary

Derealization, a feeling of unreality or disconnection from one's surroundings, can be triggered by recreational substances like cannabis, hallucinogens, and stimulants, as well as by psychiatric medications such as SSRIs and benzodiazepines. It can also occur during withdrawal from various drugs.

Key Points

• Diverse Triggers: Derealization can be caused by a wide range of substances, including illicit drugs like cannabis and hallucinogens, as well as common prescription medications.

• Psychiatric Medication Risks: Antidepressants (SSRIs) and anti-anxiety medications (benzodiazepines) are known to cause derealization, sometimes during use or, more commonly, during withdrawal.

• Neurological Disruption: Many drugs induce derealization by disrupting key neurotransmitter systems in the brain, such as those involving glutamate and serotonin.

• Recreational Drug Effects: Cannabis and dissociatives like ketamine are frequently linked to derealization due to their direct impact on perception and sense of reality.

• Don't Stop Abruptly: If derealization is suspected from a prescribed medication, it is critical to consult a doctor before discontinuing, as abrupt withdrawal can worsen symptoms.

• Seek Professional Help: Persistent derealization warrants medical evaluation, and treatment often involves addressing the underlying trigger through medication adjustment, therapy, or substance abuse treatment.

Understanding Derealization

Derealization is a type of dissociation characterized by persistent or recurrent episodes in which a person feels that their surroundings are unreal, foggy, or dreamlike. This can involve a variety of perceptual distortions, such as objects appearing blurry, flat, or colorless, and an altered sense of time. The individual experiencing derealization maintains awareness that this feeling is not reality, which distinguishes it from psychosis. While brief episodes are common, persistent derealization can be deeply distressing and interfere with daily life. These symptoms are often accompanied by depersonalization—a feeling of detachment from one's own body, thoughts, or emotions. Several different classes of drugs, both recreational and medicinal, are known to induce these dissociative states.

Recreational and Illicit Drugs

A significant number of recreational substances can trigger derealization, often by altering brain chemistry and perception.

Hallucinogens and Dissociatives

• Hallucinogens: Substances like LSD, psilocybin mushrooms, and MDMA can significantly alter perception and distort reality, leading to derealization. These effects are linked to their interaction with neurotransmitter systems, particularly serotonin, which plays a role in mood and sensory processing.
• Dissociatives: Drugs such as ketamine, PCP, and dextromethorphan (DXM) are known for causing a sense of detachment from one's body and surroundings. They work by disrupting the action of the brain chemical glutamate at NMDA receptors, which are critical for cognition and memory.
• Cannabis (Marijuana): Perhaps the most commonly cited recreational drug for causing dissociative symptoms, cannabis can induce derealization, especially at higher doses or in individuals prone to anxiety. THC, the psychoactive component, affects brain networks responsible for perception and emotion. In some cases, chronic use can lead to persistent symptoms even after stopping.

Stimulants and Alcohol

• Stimulants: Though not directly causing derealization in the same way as hallucinogens, stimulants like cocaine and methamphetamine can provoke panic attacks and anxiety, which are known triggers for dissociative episodes. Derealization may also occur during the withdrawal phase from stimulants.
• Alcohol: High volumes of alcohol can cause dissociative symptoms. For individuals with an underlying depersonalization-derealization disorder, alcohol abuse can intensify symptoms during intoxication or withdrawal.

Prescription Medications

Some prescribed medications can have derealization as a side effect or as a symptom of withdrawal.

Antidepressants

• Selective Serotonin Reuptake Inhibitors (SSRIs): Often prescribed for depression and anxiety, SSRIs like sertraline (Zoloft), fluoxetine (Prozac), and citalopram (Celexa) have been associated with emotional blunting and dissociative effects, including derealization. This can happen while on the medication or during antidepressant discontinuation syndrome when the dose is reduced or stopped.

Benzodiazepines

• Benzodiazepines: Medications such as alprazolam (Xanax) and diazepam (Valium), used for anxiety and panic disorders, can cause paradoxical effects including derealization. Long-term use and subsequent withdrawal from these drugs are particularly linked to chronic derealization symptoms.

Other Prescription Drugs

• Anticonvulsants: Some antiseizure medications like lamotrigine have been observed to cause derealization, possibly by affecting glutamate neurotransmitters.
• Antipsychotics: Though sometimes used to treat depersonalization-derealization disorder, atypical antipsychotics have also been reported to induce the syndrome in some patients, as in a case with quetiapine.
• Corticosteroids, Antibiotics, and others: Various other classes of drugs, including certain corticosteroids, antibiotics, and ADHD medications, have also been anecdotally associated with derealization.

Comparison of Drug Categories and Derealization

Drug Category	Examples	Onset of Symptoms	Mechanism/Risk Factors
Hallucinogens/Dissociatives	LSD, Ketamine, PCP, DXM	During active use	Disruption of glutamate/serotonin systems, intense perceptual changes
Cannabis	Marijuana, THC	During active use, or persistently after use	THC's effect on CB1 receptors, anxiety and stress
Stimulants	Cocaine, Methamphetamine, Amphetamines	During active use (panic attacks) or withdrawal	Anxiety, panic, psychosis, and withdrawal dysphoria
Antidepressants (SSRIs)	Sertraline, Citalopram, Fluoxetine	During initiation, while on medication, or withdrawal	Emotional blunting, serotonin system alterations
Benzodiazepines	Alprazolam, Diazepam	Paradoxical effect, long-term use, withdrawal	Dependence, abrupt changes in GABA neurotransmission
Other Prescriptions	Lamotrigine, Quetiapine	Varies	Modulation of glutamate, paradoxical effects

What to Do if Derealization Occurs

If you experience derealization, especially if it's persistent, it is crucial to consult a healthcare professional. They can evaluate your symptoms, identify potential causes, and recommend appropriate action. If a prescribed medication is suspected to be the cause, never stop taking it abruptly without medical guidance, as this can lead to serious withdrawal symptoms, including worsened derealization. Depending on the cause, treatment might involve adjusting medication, addressing underlying anxiety or trauma through therapy, or seeking substance abuse treatment. Therapy, such as Cognitive Behavioral Therapy (CBT), can help individuals reconnect with their feelings and reality.

Conclusion

Persistent or recurring derealization can be a distressing and debilitating condition, with many potential triggers, including various medications and recreational drugs. From the mind-altering effects of hallucinogens to the complex neurological changes associated with certain antidepressants and anti-anxiety medications, the pathways to drug-induced derealization are diverse. Individuals experiencing these symptoms should seek professional medical advice to identify the cause and formulate an appropriate treatment plan. For those with substance abuse issues, addressing addiction is a critical step toward recovery and resolving dissociative symptoms.

Nova Recovery Center offers further details on cannabis-induced derealization.

Frequently Asked Questions

Can derealization from drugs become permanent?

While symptoms of drug-induced derealization typically subside once the substance wears off, a small number of individuals may experience lingering or chronic symptoms. This is more likely in individuals with pre-existing risk factors or anxiety.

What is the difference between derealization and depersonalization?

Derealization is the feeling that the external world is unreal or dreamlike. Depersonalization is the feeling of being detached from one's own body, thoughts, or emotions, as if observing oneself from the outside.

Can withdrawal from antidepressants cause derealization?

Yes, derealization is a known symptom of antidepressant discontinuation syndrome, which can occur when a person reduces or stops an antidepressant after long-term use.

Do stimulants like Adderall or Ritalin cause derealization?

While not a primary cause, stimulants can trigger anxiety, panic attacks, and psychotic states, which can, in turn, lead to derealization. Derealization is also sometimes reported during stimulant withdrawal.

What should I do if a medication is causing derealization?

You should contact your prescribing doctor immediately. Do not stop taking the medication abruptly without professional guidance, as it can cause rebound or withdrawal symptoms.

Can over-the-counter medications cause derealization?

Yes, some over-the-counter medications can cause derealization, particularly cough suppressants containing dextromethorphan (DXM) when abused. Caffeine is also mentioned as a potential trigger.

Can therapy help with drug-induced derealization?

Yes, therapies like Cognitive Behavioral Therapy (CBT) can be very effective in helping people manage and overcome derealization. It can help individuals address the anxiety and other factors that perpetuate the dissociative state.