Quantum approaches to consciousness remain controversial, partly because any putative quantum state in the brain is expected to decohere rapidly in a warm, hydrated, and noisy environment. The present manuscript does not attempt to solve that biological problem directly. Instead, it treats microtubule-related interpretation as a deliberately hypothetical analogy and asks a narrower Level-A...
A 16-year-old post-pubertal female presented with mixed anxiety-depressive symptoms, prominent obsessive rumination, relationship-centered guilt, reassurance-seeking, fantasy intrusions, and difficulty separating fantasy from reality during periods of distress. Baseline scores were in the moderate range for depression and severe range for anxiety, with a Patient Health Questionnaire-9 score of...
A proportion of patients with obsessive-compulsive disorder (OCD) continue to experience disabling symptoms despite standard serotonergic treatment, antipsychotic augmentation, and psychological input. Contamination-focused OCD can be especially persistent when rituals are embedded in the home environment and reinforced by family patterns. Recent work has drawn attention to glutamatergic...
Trauma-related dissociation can present with derealisation, depersonalisation, abrupt lapses in awareness, memory gaps, and fugue-like states, and it may be difficult to treat with standard approaches alone. Glutamatergic interventions have been proposed as neuroplasticity-focused strategies because N-methyl-D-aspartate (NMDA) receptor antagonism and downstream...
Bipolar-spectrum illness emerging after traumatic brain injury (TBI) can be difficult to treat and may present with mixed or agitated depressive features that appear sensitive to glutamatergic modulation. In post-TBI cases, diagnostic certainty is often limited because irritability, impulsivity, sleep disturbance, affective lability, and cognitive change may overlap with frontal-limbic injury...
Hypochondriacal obsessive-compulsive disorder (OCD) combines intrusive health anxieties with compulsive reassurance seeking and often resists high-dose selective serotonin reuptake inhibitors and cognitive-behavioural therapy. Interest has shifted toward glutamatergic agents that mimic ketamine's rapid synaptic effects. A 34-year-old woman endured two years of recurrent fear of serious...
A 16-year-old boy with severe obsessive-compulsive disorder (OCD), characterized by health-focused obsessions, intrusive ruminations, derealization, and significant functional impairment, failed to tolerate standard serotonergic agents (escitalopram, fluoxetine) and bupropion due to worsening anxiety, somatic concerns, or headaches. An oral glutamatergic regimen was initiated with...
Major depressive disorder (MDD) is increasingly viewed as a disorder of impaired neural plasticity, yet the mechanisms underlying diverse antidepressant classes - glutamatergic (e.g., ketamine), monoaminergic (e.g., selective serotonin reuptake inhibitors (SSRIs)), and GABAergic (e.g., neurosteroids) - remain incompletely integrated. The objective of this study was to extend a...
Background: Major depressive disorder (MDD) is increasingly framed as a failure of neuroplasticity. Excessive synaptic pruning in adolescence can leave circuits fragile; later stress then unmasks the weakness, whereas ketamine and related compounds can quickly rebuild critical synapses. Clinical data show that a single treatment often gives short relief, while repeated courses reduce relapse....
Rapid-acting antidepressants show that mood can lift within hours when glutamatergic circuits shift from an "NMDA-dominant" to an "AMPA-dominant" state. Intravenous ketamine achieves this flip but is hampered by dissociation and logistics, while dextromethorphan + bupropion (Auvelity®) primarily supplies the initial NMDA blockade and yields slower, less durable benefit. We hypothesize that a...
Traditional monoaminergic medications often offer limited relief for the physical and cognitive symptoms of post-traumatic stress disorder (PTSD) and complex PTSD. Growing data now point to fast-acting, glutamate-based treatments that boost synaptic plasticity and interrupt fear-conditioned neural circuits. We report four sequential cases of hard-to-treat trauma-spectrum disorders-somatic PTSD,...
Background: Bipolar disorder secondary to traumatic brain injury (TBI) is common, mechanistically distinct, and notoriously treatment-resistant. Rapid-acting glutamatergic antidepressants such as ketamine are effective in bipolar depression but remain inaccessible to most patients.Case presentation: We describe a woman in her mid-thirties with documented right frontal atrophy after a severe...
Cognitive impairment—rather than psychosis or mood instability—often drives long-term disability in schizoaffective disorder, yet current antipsychotic and mood-stabilising regimens offer little relief. We describe a 22-year-old man with schizoaffective disorder, bipolar type, whose persistent "brain fog" jeopardised university graduation despite euthymic mood and quiescent psychosis on...
Off-label use of glutamatergic agents is increasingly common in psychiatry, yet standardized protocols for outpatient dosing are lacking. This report describes the pharmacological management and dosing adjustments required for three patients receiving dextromethorphan (DXM) and piracetam for obsessive–compulsive disorder.Three adult women with severe OCD were treated in a routine clinical...