Differed spontaneous dissociative symptoms following the use of esketamine intranasal spray in a patient suffering from treatment-resistant depression: a case report.

IF 2.1 3区医学 Q3 PHARMACOLOGY & PHARMACY

International Clinical Psychopharmacology Pub Date : 2025-01-01 Epub Date: 2024-01-22 DOI:10.1097/YIC.0000000000000527

Louis Chevalier, Samuel Bulteau, Louis Cheval, Jalal Charron, Anne Sauvaget, Andrew Laurin

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引用次数: 0

Abstract

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.

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病例报告：一名耐药抑郁症患者使用埃司氯胺酮鼻内喷雾剂后出现的自发分离症状。

在法国，鼻内注射艾司氯胺酮被用于治疗难治性抑郁症。解离症状是治疗过程中常见的副作用。我们报告了一例使用埃斯氯胺酮后出现延迟性自发性分离症状的病例。一名患有难治性抑郁症的20岁女性接受了艾司氯胺酮治疗。解离症状在治疗过程中出现，并在远处持续存在，常常伴有焦虑。延迟性分离现象在使用埃斯氯胺酮治疗的第四周内消失。文献主要讨论了埃斯氯胺酮治疗过程中的分离现象，而关于不同的自发发作的数据有限。关于这些解离现象的发生机制，我们讨论了三种假设，包括埃斯氯胺酮的直接作用、中枢神经系统敏化和焦虑诱发的解离。我们介绍了首例鼻内注射艾司氯胺酮治疗耐药抑郁症后出现不同自发解离效应的病例。我们的主要假设是，埃斯氯胺酮可能会成为解离体验的 "模式"，从而提高患者在其他解离情况下（如急性焦虑发作）辨别这些现象的能力。要验证这一假设，还需要进一步的研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Clinical Psychopharmacology 医学-精神病学

CiteScore

4.40

自引率

23.10%

发文量

审稿时长

>12 weeks

期刊介绍： International Clinical Psychopharmacology provides an essential link between research and clinical practice throughout psychopharmacology. It reports on studies in human subjects, both healthy volunteers and patients, which relate the effects of drugs on psychological processes. A major objective of the journal is to publish fully refereed papers which throw light on the ways in which the study of psychotropic drugs can increase our understanding of psychopharmacology. To this end the journal publishes results of early Phase I and II studies, as well as those of controlled clinical trials of psychotropic drugs in Phase II and IV. Other topics covered include the epidemiology of psychotropic drug prescribing and drug taking, the sociology of psychotropic drugs including compliance, and research into the safety and adverse effects of these compounds.