Nantes Université, CHU Nantes, F-44000.
Nantes Université, CHU Nantes, INSERM, MethodS in Patients-centered outcomes and HEalth Research, SPHERE.
Int Clin Psychopharmacol. 2025 Jan 1;40(1):37-40. doi: 10.1097/YIC.0000000000000527. Epub 2024 Jan 22.
Intranasal esketamine is used in France for treatment-resistant depression. Dissociative symptoms are common side effects during treatment sessions. We report a case of delayed spontaneous dissociative symptoms following esketamine administration. A 20-year-old female with treatment-resistant depression received esketamine treatment. Dissociative symptoms occurred during sessions and persisted at a distance, often accompanied by anxiety. Delayed dissociative phenomena disappeared within the fourth week of treatment by esketamine. The literature mainly discusses dissociation during esketamine treatment sessions, with limited data on differed spontaneous episodes. Three hypotheses are discussed concerning the mechanism of occurrence of these dissociative phenomena, including esketamine's direct effect, central nervous system sensitization, and anxiety-induced dissociation. We present the first case of differed spontaneous dissociative effects after intranasal esketamine administration for treatment-resistant depression. Our main hypothesis suggests that esketamine may act as a 'pattern' for dissociative experiences, heightening the patient's ability to discern these phenomena during other instances of dissociation, such as acute anxiety attacks. Further research is needed to validate this hypothesis.
鼻腔内给予氯胺酮在法国被用于治疗抵抗性抑郁症。在治疗过程中，分离症状是常见的副作用。我们报告了一例氯胺酮给药后延迟出现的自发性分离症状。一名 20 岁的女性患有治疗抵抗性抑郁症，接受了氯胺酮治疗。分离症状在治疗过程中出现，并在治疗结束后持续存在，常伴有焦虑。氯胺酮治疗的第四周，延迟的分离症状消失。文献主要讨论了氯胺酮治疗过程中的分离，关于不同自发性发作的数据有限。我们讨论了发生这些分离现象的三种机制假说，包括氯胺酮的直接作用、中枢神经系统敏化和焦虑引起的分离。我们报告了首例鼻腔内给予氯胺酮治疗抵抗性抑郁症后出现的不同自发性分离效应。我们的主要假设是，氯胺酮可能作为分离体验的“模式”，增强患者在其他分离情况下（如急性焦虑发作）识别这些现象的能力。需要进一步的研究来验证这一假设。
