Reviewed by: Pavel Kornilov, MD, psychiatrist · updated 6 Nov 2026
Key facts
- ICD-10 code
- F48.1
- Who treats you
- a psychiatrist; a psychotherapist joins for a course of therapy
- Format
- video consultations, with referrals for in-person evaluation when needed
- Duration
- initial appointment about an hour; a course of therapy is usually 10–20 sessions
- Confidentiality
- you can reach out without your full name; your information is protected by medical confidentiality
- When it’s urgent
- hearing voices, delusions, suicidal thoughts or loss of consciousness — call 103 or 112
- Outcome
- an understanding of the mechanism, less anxiety, and the world gradually feeling “real” again
What you should know
People with derealization are often afraid they’re losing their mind, and that very fear keeps them from seeking help. We make the first step as simple as possible: you write on WhatsApp that the world around you looks flat and foreign and your own reflection in the mirror seems unfamiliar. The administrator finds a time, and within a few hours a psychiatrist on video calmly asks about your symptoms. There’s no need to travel through noisy Almaty, where bright lights and crowds can only intensify the sense of unreality.
Derealization and depersonalization are frightening, but on their own they don’t mean psychosis: the person remains aware that something is off with their perception, and that is an important distinction. Most often, these sensations are the nervous system’s defensive reaction to intense anxiety, stress or exhaustion. A Psychiatry Online psychiatrist helps you understand what lies behind the symptoms, explains how they work and selects treatment. Simply understanding what’s happening often brings noticeable relief.
Signs of Derealization and Depersonalization
- the world around you seems unreal, flat, as if behind glass or in a fog
- familiar places and people feel foreign or like stage scenery
- your own body feels alien, as if you were watching yourself from the outside
- your emotions are dulled; you don’t feel your usual joy or sadness
- time flows strangely: sometimes too fast, sometimes as if it has stopped
- you realize the sensations aren’t normal and are afraid of “going crazy”
- the state gets worse with stress, lack of sleep, crowds and bright light
If at least two points apply and the state lasts longer than two weeks, it is worth seeing a specialist. Phone consultation is free. If life is at risk, call 112 or 103.
Why Derealization Happens
Derealization and depersonalization are the nervous system’s way of trying to protect itself from overload: under intense anxiety, it seems to “turn down” perception. That’s why these sensations often accompany panic attacks, generalized anxiety, depression and PTSD. Sometimes they appear after severe stress or prolonged sleep deprivation. Less often the cause is a neurological disease, epilepsy or a medication side effect, which is why a doctor’s assessment matters.
The first episode often occurs after using cannabis or other substances, during a hangover or after abruptly stopping medication. Then fear joins the sensations: the person keeps checking whether the world is real, and this feeds the state. The rhythm of a big city — chronic sleep deprivation, information overload, constant screen time, hours in traffic and noise — can keep the symptoms going for months.
How an Online Appointment for Derealization Works
You join from a quiet place with soft lighting — this matters for people with derealization. The psychiatrist asks in detail when the sensations began, under what circumstances, how often they occur and what makes them worse. Alcohol and substance use, medications, sleep, anxiety and mood are always discussed. The doctor explains what is happening to your perception and, already at the first session, gives recommendations on how to reduce the intensity of the symptoms.
A neurological examination can’t be done online. If derealization comes with episodes of losing consciousness, seizures or speech problems, or appeared after a head injury, the doctor will refer you to a neurologist for an in-person examination, EEG or MRI. Hearing voices, delusions or severe suicidal thoughts call for an in-person visit or hospitalization, and if a life is in danger, call 103 or 112.
How we help
Psychoeducation
Explaining how derealization works is the first and a very important step. When a person understands that it’s a defensive reaction to anxiety rather than a sign of psychosis, fear decreases, and the symptoms weaken along with it. The doctor explains why you shouldn’t keep checking reality and suggests simple ways to shift your attention.
Cognitive Behavioral Therapy
CBT helps break the cycle of “strange sensation — fear — even more sensations.” You learn to relate to the symptoms differently, reduce anxious self-monitoring and gradually return to everyday life without waiting for the sensations to disappear completely. Video sessions follow the same structure as in-person ones.
Treating the Underlying Disorder
If derealization is part of panic disorder, generalized anxiety, depression or PTSD, treatment targets the underlying condition. A psychiatrist may suggest medications from the relevant classes. There are no specific drugs “for derealization,” so the choice is based on the overall symptom picture and monitored at online follow-up appointments.
Grounding Techniques
Sensory exercises — focusing on sounds, smells, textures or cold water — help bring you back to the “here and now” during an episode. A Psychiatry Online specialist practices them with you during sessions so you can use them anywhere: in a café on Panfilov Street, on a bus or at home. Regular sleep and avoiding substances strengthen the effect.
Myths and facts
MythDerealization is the first sign of schizophrenia
FactWith derealization, a person understands that the sensations aren’t normal, whereas in psychosis that insight is lost. Derealization is most often linked to anxiety and stress. A psychiatrist gives the final assessment.
MythIf the sensations don’t go away, they’re permanent
FactEven long-lasting derealization is treatable. When anxiety decreases and a person stops constantly checking their sensations, perception gradually recovers, and the world feels familiar again.
MythYou need to fight the sensations and keep checking reality
FactConstant checking strengthens fixation on the symptom and sustains anxiety. The opposite helps: acknowledge the sensations, don’t fight them and gently bring your attention back to everyday tasks and the people around you.
How an online appointment works
- Message or callWrite on WhatsApp or call — our coordinator replies within minutes, day or night. You don't have to give your surname.
- Doctor and timeWe match you with a psychiatrist, addiction specialist or psychotherapist and agree on a time — often the same day.
- Video consultationA secure 50–60 minute video call: the doctor takes a detailed history and uses standardised scales if needed.
- Treatment planYou receive a clear summary, recommendations and a plan: what we do online and what needs an in-person visit or home call.
- Follow-upOnline follow-up sessions, messenger contact with your doctor, and treatment adjustments until you get a stable result.
Prices in Almaty
| Online psychiatrist consultation (50–60 min) | 15 000 ₸ |
| Follow-up online consultation | 12 000 ₸ |
| One month of online psychiatric care | 60 000 ₸ |
The final cost is agreed before treatment starts. Prices are in tenge and do not constitute a public offer.
Where to get help
Psychiatry Online in Almaty: same-day video appointments and two branches for in-person visits — 129 Kurmangazy St., office 8, Almaty and 110 Bogenbay batyra St., office 15, Almaty. Our mobile team works around the clock: all city districts and nearby settlements. If you live elsewhere in Almaty and Almaty Region, starting online is usually easiest.
Confidential and private
An online appointment in Almaty is first of all about privacy: no clinic visit, no waiting room. A private room and headphones are enough. Data is stored in a secure system with restricted access and does not enter any state registry without legal grounds.
Questions and answers
Is derealization dangerous?
Derealization itself isn’t life-threatening and doesn’t turn into psychosis. But it seriously lowers quality of life and often points to an anxiety or depressive disorder that needs treatment. That’s why a consultation with a psychiatrist is important.
Can I get help online?
Yes. Diagnosis, psychoeducation, psychotherapy and monitoring of medication all work well by video. In-person care is needed only for neurological tests if an organic cause is suspected, and for emergencies.
How long does treatment take?
It depends on the cause and how long the symptoms have lasted. When derealization is driven by anxiety, improvement often comes within a few weeks. With chronic depersonalization disorder, treatment may take several months. The doctor regularly assesses your progress.
My derealization started after cannabis. What should I do?
Stopping use is the first and essential step. See a psychiatrist: they’ll assess your condition without judgment and suggest treatment. Information about substance use is protected by medical confidentiality and isn’t shared with third parties without your consent.
Can derealization go away on its own?
Sometimes stress-related episodes pass once the situation is resolved. But if the sensations last for weeks, get worse or cause intense fear, it’s better not to wait. The earlier treatment starts, the faster perception usually recovers.
Is online treatment convenient if I live in Kaskelen?
Yes. Video appointments are available in any district of Almaty and in the suburbs — Kaskelen, Talgar, Konaev. For people with derealization, not having to travel through the noisy city is especially important. All you need is a stable connection and a quiet place to talk.
Where can I be seen in Almaty?
Online — from anywhere in the city or region. In person — at two branches: 129 Kurmangazy St., office 8, Almaty and 110 Bogenbay batyra St., office 15, Almaty. Both are open 24/7; home visits cover all city districts and nearby settlements.
Sources and methodology
This page was prepared by the Psychiatry Online medical editorial team based on:
- International Classification of Diseases ICD-10 and ICD-11, World Health Organization
- Clinical diagnosis and treatment protocols of the Ministry of Health of the Republic of Kazakhstan
- Code of the Republic of Kazakhstan “On Public Health and the Healthcare System”
- NICE (UK) and APA (US) guidelines on the treatment of mental disorders
- WHO recommendations on telemedicine and digital health
This information is for reference only and does not replace a consultation with a specialist. Editorial policy
