and opioid antagonists (ex: naltrexone). Cognitive behavioral therapy An open study of cognitive behavioral therapy has aimed to help patients reinterpret their symptoms in a nonthreatening way, leading to an improvement on several standardized measures. A standardized treatment for DPDR based on cognitive behavioral principles was published in the Netherlands in 2011. Medications Neither antidepressants nor antipsychotics have been found to be useful; additionally, antipsychotics can worsen symptoms of depersonalisation. Tentative evidence supports use of naloxone and naltrexone. A combination of an SSRI and a benzodiazepine has been proposed to be useful for DPDR patients with anxiety. Modafinil used alone has been reported to be effective in a subgroup of individuals with depersonalization disorder (those who have attentional impairments, under-arousal and hypersomnia). However, clinical trials have not been conducted. Repetitive transcranial magnetic stimulation (rTMS) Some studies have found repetitive transcranial magnetic stimulation (rTMS) to be helpful. One study examined 12 patients with DPDR that were treated with right temporoparietal junction (TPJ) rTMS and found that 50% showed improvement after three weeks of treatment. Five of the participants received an additional three weeks of treatment and reported overall a 68% improvement in their symptoms. Treating patients with rTMS specifically at the TPJ may be an alternative treatment. Prognosis DPDR is typically chronic and continuous though some individuals report experiencing periods of remission. Exacerbations can be caused by psychologically stressful situations. Michal et al. (2016) analyzed a 2 case series on patients with DPDR and agreed that the condition tended to be chronic. Epidemiology Men and women are diagnosed in equal numbers with depersonalization disorder. A 1991 study on a sample from Winnipeg, Manitoba estimated the prevalence of depersonalization disorder at 2.4% of the population. A 2008 review of several studies estimated the prevalence between 0.8% and 1.9%. This disorder is episodic in about one-third of individuals, with each episode lasting from hours to months at a time. Depersonalization can begin episodically, and later become continuous at constant or varying intensity. Onset is typically during the teenage years or early 20s, although some report being depersonalized as long as they can remember, and others report a later onset. The onset can be acute or insidious. With acute onset, some individuals remember the exact time and place of their first experience of depersonalization. This may follow a prolonged period of severe stress, a traumatic event, an episode of another mental illness, or drug