The use of psychoactive substances can temporarily alter consciousness, sometimes involving a profound sense of detachment known as dissociation. This drug-induced phenomenon requires exploring the specific compounds and neurological pathways involved. This exploration focuses on how certain drugs can trigger feelings of unreality.
Defining Derealization and Depersonalization
Dissociative experiences are classified into two distinct, yet frequently co-occurring, states: depersonalization and derealization. Depersonalization involves a subjective feeling of detachment from one’s own body, thoughts, feelings, or actions. Individuals often describe this state as observing themselves from a distance, like watching a movie of their own life, sometimes feeling emotionally or physically numb.
Derealization is a detachment from the external world and one’s surroundings. The environment may appear foggy, dreamlike, distant, or visually distorted, making the world seem artificial or unreal. While both conditions are unsettling, the person maintains an understanding that these feelings are not reality, a concept known as intact reality testing.
Specific Substances Linked to Derealization
Many substances that impact the central nervous system can induce dissociative states. Dissociative anesthetics are direct triggers, known to cause depersonalization and derealization during intoxication. Examples include ketamine, phencyclidine (PCP), and dextromethorphan (DXM).
Classic psychedelics, including lysergic acid diethylamide (LSD) and psilocybin, are also common triggers, distorting self-perception and leading to a dream-like state of unreality. Cannabis, particularly high-potency tetrahydrocannabinol (THC) strains, frequently induces derealization, especially in individuals with pre-existing anxiety. Even stimulants like cocaine and amphetamines can provoke dissociative symptoms, often indirectly by causing extreme anxiety or panic attacks. Withdrawal from certain prescription medications, such as benzodiazepines, can also trigger episodes due to severe anxiety and neurological rebound effects.
Neurochemical Mechanisms of Drug-Induced Derealization
The ability of different drug classes to cause dissociation involves a complex interplay of neurochemical systems. A prominent mechanism involves the antagonism of the N-methyl-D-aspartate (NMDA) receptor, a type of glutamate receptor. Dissociative drugs like ketamine block the NMDA receptor, disrupting the flow of sensory and cognitive information and leading to the feeling of being disconnected from the mind and body.
Other substances affect the serotonergic and dopaminergic systems, which modulate mood and perception. Psychedelics primarily act on serotonin receptors, causing widespread changes in sensory processing that result in derealization and a distorted sense of time. Stimulants, by increasing dopamine and norepinephrine, can induce severe anxiety and panic, subsequently triggering dissociation. The balance between the excitatory neurotransmitter glutamate and the inhibitory neurotransmitter GABA is also destabilized by drug use, contributing to the anxiety that often precedes a dissociative episode.
Duration and Recovery from Substance-Induced Episodes
The timeline for a drug-induced dissociative episode varies based on the substance and individual physiology. Acute episodes typically last only as long as the substance is active; for instance, cannabis-induced depersonalization often dissipates within hours. However, substance use can sometimes act as the initial trigger for a persistent condition known as Depersonalization/Derealization Disorder (DPDRD).
When symptoms endure for weeks or months after the drug’s effects have cleared, the episode is no longer considered transient intoxication. This persistent form of DPDRD requires professional evaluation and treatment. Medical intervention is recommended if symptoms are severely distressing, impair daily functioning, or persist beyond a few weeks following the cessation of substance use.