Department of Psychiatry, The Medical Research Network LLC, New York, New York, USA.
Int Clin Psychopharmacol. 2021 Jan;36(1):54-57. doi: 10.1097/YIC.0000000000000327.
Patients with treatment-resistant depression (TRD) treated with esketamine nasal spray commonly experience transient symptoms of dissociation. Manifestations of dissociation, such as feelings of detachment from the environment, can cause considerable anxiety for patients. Nonpharmacologic interventions may help clinicians to manage associated anxiety and confusion due to dissociation following administration of esketamine nasal spray. We present the case of a 64-year-old woman with major depressive disorder who participated in a clinical trial evaluating the efficacy and safety of esketamine nasal spray in conjunction with an oral antidepressant for TRD. The patient received flexible doses of esketamine nasal spray (56 or 84 mg) twice weekly for 4 weeks. On treatment day 1, the patient was administered 56 mg of esketamine nasal spray using two nasal spray devices (28 mg per device). Twenty minutes after the first esketamine nasal spray device was administered, the patient experienced a dissociative episode lasting 40 minutes that caused anxiety and confusion. The patient was encouraged to listen to music during treatment sessions, which resulted in notable improvement of her symptoms. Listening to music of choice immediately following esketamine nasal spray administration along with reassurance from staff may help manage confusion and anxiety associated with dissociation.
接受鼻腔内用氯胺酮治疗的治疗抵抗性抑郁症（TRD）患者通常会经历短暂的分离症状。分离症状的表现，如与环境脱离的感觉，可能会给患者带来相当大的焦虑。非药物干预措施可能有助于临床医生管理由于鼻腔内用氯胺酮给药后分离引起的相关焦虑和混乱。我们报告了一例 64 岁女性患者的病例，该患者患有重度抑郁症，参加了一项评估鼻腔内用氯胺酮与口服抗抑郁药联合治疗 TRD 的疗效和安全性的临床试验。患者每周接受两次鼻腔内用氯胺酮（56 或 84mg）的灵活剂量治疗 4 周。在治疗第 1 天，患者使用两个鼻腔喷雾装置（每个装置 28mg）给予 56mg 的鼻腔内用氯胺酮。在第一次鼻腔内用氯胺酮喷雾装置给药后 20 分钟，患者经历了持续 40 分钟的分离发作，引起焦虑和混乱。鼓励患者在治疗期间听音乐，这导致她的症状明显改善。在给予鼻腔内用氯胺酮后立即听患者选择的音乐，并得到工作人员的安慰，可能有助于管理与分离相关的混乱和焦虑。
