What Medications Can Cause Dissociation?

October 10, 2025 •

5 min read

Research indicates that a wide range of substances, both prescribed and illicit, are capable of inducing dissociative states. Understanding what medications can cause dissociation is crucial for patients and clinicians to differentiate between mental health conditions and medication side effects. These experiences can range from a feeling of detachment from oneself to a sense of unreality in one's surroundings.

Quick Summary

A variety of prescription, over-the-counter, and recreational substances can induce dissociative symptoms like depersonalization and derealization by altering brain neurotransmitter systems. This article explores specific drug classes and their potential to cause feelings of detachment from oneself or one's environment.

Key Points

Diverse Drug Classes: Numerous medications and substances, including anesthetics like ketamine, benzodiazepines, antidepressants, and common hallucinogens, are known to cause dissociation by altering brain chemistry.
Altered Neurotransmitters: Dissociation caused by drugs often results from interference with key neurotransmitters, particularly glutamate through NMDA receptor antagonism, as seen with ketamine and PCP.
Distinguishing Symptoms: Drug-induced dissociation is often acute and transient, associated with intoxication or withdrawal, while persistent dissociative symptoms might indicate an underlying mental health disorder.
Depersonalization and Derealization: Common forms of drug-induced dissociation include depersonalization (feeling detached from oneself) and derealization (feeling that one's surroundings are unreal).
Recreational vs. Therapeutic Use: Dissociation can occur both from the prescribed use of certain medications (e.g., ketamine, SSRIs) and from the recreational abuse of illicit drugs or high doses of OTC products like DXM.
Importance of Medical Consultation: If experiencing dissociative side effects from medication, consult a healthcare provider before discontinuing treatment, as managing the dosage or switching medications may be necessary.

Understanding Drug-Induced Dissociation

Dissociation is a mental process that causes a lack of connection in a person's thoughts, memory, feelings, actions, or sense of identity. While it can be a symptom of a mental health condition like PTSD or a dissociative disorder, it can also be a side effect of certain medications or drug use. Drug-induced dissociation often occurs because a substance interferes with the brain's neurotransmitter systems, particularly those involving glutamate and serotonin. The resulting altered state of consciousness can manifest as depersonalization (feeling detached from your own body) or derealization (feeling that your surroundings are unreal).

Prescription Medications Linked to Dissociation

Several classes of prescribed drugs, when taken as directed or in excess, can trigger dissociative experiences. It is important to discuss any such side effects with a healthcare provider before making any changes to a prescribed regimen.

Anesthetics and Sedatives

Ketamine and Esketamine: Ketamine is a dissociative anesthetic used in medicine for sedation and anesthesia. Its derivative, esketamine, is FDA-approved for treatment-resistant depression. Both can cause temporary dissociative effects, including feelings of floating or detachment from the body. Recreational use of ketamine, often called 'Special K,' is well-known for its dissociative effects, including a profound sense of detachment known as a 'K-hole'.
Benzodiazepines: These drugs, such as lorazepam (Ativan) and alprazolam (Xanax), are used to treat anxiety and insomnia. When used in high doses or inappropriately, they can induce dissociative states, amnesia, and feelings of unreality.
Barbiturates: Similar to benzodiazepines, these older sedatives can cause dissociative-like effects.

Psychiatric Medications

Antidepressants (SSRIs): Some patients report experiencing depersonalization and derealization, as well as emotional blunting, while taking selective serotonin reuptake inhibitors (SSRIs). The relationship between SSRIs and dissociation is not fully understood, but it may be linked to changes in serotonin levels.
Opioid Use Disorder Medications: A study found that individuals prescribed buprenorphine had higher average dissociative symptom scores than those taking methadone or naltrexone. Dissociative symptoms in this population can potentially interfere with the success of substance use treatment.

Other Prescribed Drugs

Beta-Blockers: Medications like propranolol, used for blood pressure and anxiety, have been reported to cause dissociative-like symptoms in some individuals.
Other Medications: Lists compiled by drug databases also indicate that various other prescription drugs, such as digoxin, diltiazem, and sildenafil, have been associated with reports of dissociation as a side effect.

Over-the-Counter and Illicit Drugs

Dissociation is also a well-documented side effect of numerous substances that are either available over-the-counter (OTC) or used recreationally. These drugs often affect the brain's glutamate and other neurotransmitter systems in ways that produce profound alterations in perception and reality.

Dextromethorphan (DXM): Commonly found in OTC cough suppressants, DXM is frequently abused in high doses for its dissociative effects, which are similar to those of PCP and ketamine. Misuse can lead to dangerous side effects, including elevated heart rate and blood pressure.
Phencyclidine (PCP): Originally developed as an anesthetic, PCP is a powerful dissociative drug known for causing feelings of invulnerability and detachment, as well as severe mood swings, paranoia, and hallucinations.
Cannabis (Marijuana): While primarily known for its psychoactive effects, cannabis can trigger episodes of depersonalization, especially in higher doses or in individuals with a predisposition to anxiety.
Hallucinogens: Classic hallucinogens like LSD, psilocybin (magic mushrooms), and mescaline can cause derealization and depersonalization. They primarily affect the brain's serotonin system, altering perception.
Salvia Divinorum: This psychoactive plant activates kappa opioid receptors in the brain and can induce intense, though short-lived, dissociative and hallucinogenic effects.

Medication-Induced Dissociation vs. Primary Dissociative Disorders

It is important for clinicians to distinguish between substance-induced dissociative symptoms and a pre-existing dissociative disorder. A substance-induced dissociative state is directly caused by the pharmacological effects of a substance and typically subsides once the drug's effects wear off. A primary dissociative disorder is a persistent condition that exists independent of substance use. However, substance use can trigger or exacerbate symptoms in an individual with an underlying dissociative disorder.

Comparison Table: Common Substances and Dissociative Effects


Substance Class	Examples	Type of Dissociation	Duration	Medical Use	Recreational Potential
Dissociative Anesthetics	Ketamine, Esketamine	Depersonalization, Derealization, Out-of-Body Experiences	Hours	Yes (anesthesia, depression)	High
Benzodiazepines	Lorazepam, Alprazolam	Amnesia, Detachment, Unreality	Varies	Yes (anxiety, sleep)	High
SSRIs	Sertraline, Lexapro	Depersonalization, Derealization, Emotional Blunting	Can be chronic	Yes (depression, anxiety)	No
Dextromethorphan (DXM)	Cough Syrups (high doses)	Depersonalization, Derealization, Hallucinations	Hours	Yes (cough suppressant)	High
Cannabis	Marijuana	Derealization, Depersonalization	Varies	Yes (pain, nausea)	High
Classic Hallucinogens	LSD, Psilocybin	Derealization, Depersonalization, Visions	Hours	Investigational	High

The Role of Glutamate and Neurotransmitters

Many dissociative drugs, such as ketamine, PCP, and DXM, exert their primary effect by antagonizing (blocking) N-methyl-D-aspartate (NMDA) receptors in the brain. The NMDA receptor is a type of glutamate receptor, and by blocking its action, these drugs interfere with the normal signaling of glutamate, a key neurotransmitter involved in memory, learning, and emotion. This disruption is what leads to the profound perceptual alterations and feelings of detachment characteristic of dissociative states. Other substances, like classic hallucinogens, primarily affect the serotonin system, which also plays a significant role in mood, perception, and sense of self, and can therefore also cause dissociative symptoms.

Conclusion

Numerous medications, ranging from prescribed anesthetics and antidepressants to recreational substances, have the potential to cause dissociation. This phenomenon, which can include symptoms like depersonalization and derealization, is often linked to the drug's impact on key neurotransmitter systems, especially those involving glutamate. While drug-induced dissociation is typically transient, it can be distressing and may signal an underlying sensitivity or issue. It is essential for individuals experiencing dissociative symptoms in connection with medication to consult a healthcare professional to determine the cause and appropriate course of action. For more information on the effects of different substances on the brain, consult reputable sources such as the National Institute on Drug Abuse (NIDA).

Identifying Drug-Induced Dissociation

Recognizing symptoms: Identifying feelings of detachment from your body (depersonalization) or from reality (derealization) is the first step in recognizing drug-induced dissociation.
Reviewing medications: A careful review of all prescribed, OTC, and recreational substances being used can help identify potential culprits.
Understanding onset and offset: Drug-induced dissociation often aligns with the substance's effects, starting shortly after use and fading as the drug wears off, distinguishing it from chronic conditions.
Consulting a professional: It is crucial to consult a healthcare provider to differentiate between medication side effects and a psychiatric disorder, especially if symptoms persist.
Addressing the root cause: Discontinuing or adjusting the causative medication under medical supervision is typically the solution for substance-induced dissociation.

Seeking Help for Drug-Induced Dissociation

Consultation with a professional: The first step should always be discussing symptoms with a doctor or psychiatrist to rule out other medical or psychological causes.
Medication adjustment: A healthcare provider may recommend adjusting the dose, switching to an alternative medication, or tapering off the drug if it is identified as the cause.
Supportive therapy: Psychological support, such as talk therapy, can be beneficial for those struggling with the distress caused by drug-induced dissociation.
Substance abuse treatment: If recreational drug use is the cause, treatment for substance abuse may be necessary to address both the dissociation and the addiction.
Lifestyle interventions: Regular exercise, mindfulness techniques, and other healthy habits can help manage stress and improve overall mental well-being, which can help mitigate dissociative symptoms.

Frequently Asked Questions

Yes, some antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), can cause dissociative experiences such as depersonalization and derealization in certain individuals. This is often an unwanted side effect that can persist while on the medication.

Cannabis use can trigger episodes of depersonalization or derealization, particularly in high doses or in individuals who are prone to anxiety. It alters the brain's processing of self-perception and can disrupt emotional regulation.

No, ketamine-induced dissociation is a temporary side effect of the drug's action on NMDA receptors. While it produces similar symptoms, it is distinct from a clinical dissociative disorder, which is a chronic condition.

Yes, dissociative experiences can occur during withdrawal from certain substances, including alcohol, benzodiazepines, and other prescription medications.

Yes, when abused in high doses, the ingredient dextromethorphan (DXM) found in many over-the-counter cough syrups and pills can cause dissociative effects similar to those of PCP or ketamine.

Depersonalization is the feeling of being detached from one's own body or mind, like watching oneself from a distance. Derealization is the feeling that one's surroundings or the world are unreal or dreamlike.

You should not stop taking a prescribed medication abruptly. The first step is to consult your healthcare provider, who can evaluate the side effect, potentially adjust your dose, or recommend an alternative treatment.