Brief Answer:
Depersonalisation or derealisation could occur in severe anxiety.

Detailed Answer:
Hello thanks for asking from HCM for your health related doubts

Depersonalisation is feeling of detachment of self while derealisation is altered perception or experience of external world. Both type of psychopathological symptoms could occur due to a number of causes. If we consider the biochemical causes then altered neuronal circuits in some brain areas results in symptoms of derealisation or depersonalisation. But as per DSM these are classified under Dissociative disorders.

Chronic anxiety states, severe stress, some times traumatic events in life usually trigger the symptoms of derealisation or depersonalisation. Chronic cannabis use even is known to cause these symptoms.

If you are doing otherwise normal and are experiencing the symptoms since long then proper evaluation is needed.

Do you have any history of anxiety or chronic stress?

Is there any persistent stress or history of traumatic events in your life?

Are there any triggering factors that result in symptoms of derealisation or depersonalisation?

Please provide these details so that we proceed further towards management.

Thanks. Take care

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Brief Answer:
Anxiety is possible cause of obsessive thoughts images you are having.

Detailed Answer:
Hello again

Thanks for providing details. As I've mentioned severe anxiety could result in feelings of derealisation or depersonalisation. Persistent pervasive stress in long term leads to anxiety. Its common to develop derealisation or depersonalisation after major panic attacks.

The symptoms like scary intrusive thoughts, images could be due to anxiety only. Intrusive unwanted thoughts or images which are dominating and cause significant distress occur due to obsessions. Obsessive compulsive disorder is also an anxiety disorder. I am not saying that you have OCD but these thoughts are most probably due to obsessive thoughts.

Anxiety is the cause of symptoms you're having. A lot of possible reasons cause anxiety and obsessive thoughts. Reduced serotonergic neurotransmission results in anxiety. Developmental factors, psychological factors, repetitive stress are the reasons for development of anxiety.

But anxiety can be treated with medicines as well as psychosocial methods like behaviour therapy. SSRIs like Fluoxetine or Paroxetine are commonly preferred for anxiety and also for intrusive thoughts. The medicines will definitely help you to come out of anxiety.

So I'd advise you to visit a psychiatrist for evaluation.

Thanks.

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Brief Answer:
The symptoms don't indicate psychosis.

Detailed Answer:
Hello thanks for asking again

Yes when ever any SSRI or SNRI drug is started or increased in dose for first few days increased restlessness or anxiety are seen. This reduces by own in some days so no need to worry.

No I don't think these thoughts or images indicate psychosis. You have complete insight about these thoughts. This is not psychosis but due to anxiety only. In psychosis there is absence of insight and hallucinations are seen. Just continue to take Effexor as advised and if needed ask your doctor to augment the drug with some other antidepressant or mood stabiliser.

Thanks.

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