Case Report: A possible association between significant dissociations after esketamine treatment and histrionic personality disorder
Veronika Savica, Liene Sīle, Māris Taube
Frontiers in Psychiatry December 17, 2025 DOI: 10.3389/fpsyt.2025.1666781 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Case report Peer reviewed |
|---|---|
| Sample size | 1 |
| Population | Patient with histrionic personality disorder undergoing esketamine therapy |
| Intervention | Esketamine nasal spray |
| Topics | Esketamine |
| Keywords | Dissociation chemistry Dissociative identity disorder Dissociative disorders Multiple personality disorder Trait Adverse effect Clinical psychology Borderline personality disorder Dissociative experiences scale Electroconvulsive therapy studies |
| Citations | 1 |
| Key findings | Certain personality traits characteristic of histrionic personality disorder may heighten vulnerability to esketamine-induced dissociation. |
Abstract
Dissociation is a complex and transdiagnostic phenomenon defined as a disruption of, or discontinuity in, the normal, subjective integration of one or more aspects of psychological functioning. Dissociation has been identified as one of the most frequently occurring adverse effects associated with the use of esketamine nasal sprays. Individuals with high trait dissociation may be at a higher risk of experiencing an induced dissociative state and a significantly higher risk of experiencing severe induced dissociation. High esketamine-induced dissociation may act as a predictor of optimal therapeutic response, rather than solely an adverse effect. This case report describes an unusually intense and persistent dissociative reaction in a patient with histrionic personality disorder (HPD) undergoing esketamine therapy. The patient's marked dissociation upon treatment initiation raises the possibility that certain personality traits characteristic of HPD may heighten vulnerability to esketamine-induced dissociation. By explicitly examining a potential link between HPD and dissociation severity, this case highlights the importance of identifying patient-level factors that may amplify dissociative responses. Such knowledge has practical clinical implications for risk stratification, patient education regarding expected side effects, ensuring increased attention during the procedure.
Comparable studies
Other case reports and case series on esketamine, most cited first.
Citations in the library
Cites 14
- Efficacy and Safety of Flexibly Dosed Esketamine Nasal Spray Combined With a Newly Initiated Oral Antidepressant in Treatment-Resistant Depression: A Randomized Double-Blind Active-Controlled Study American Journal of Psychiatry May 21, 2019
- Double-Blind, Placebo-Controlled, Dose-Ranging Trial of Intravenous Ketamine as Adjunctive Therapy in Treatment-Resistant Depression (TRD) Molecular Psychiatry October 3, 2018
- Do the dissociative side effects of ketamine mediate its antidepressant effects? Journal of Affective Disorders February 18, 2014
- Features of Dissociation Differentially Predict Antidepressant Response to Ketamine in Treatment-Resistant Depression Journal of Affective Disorders February 17, 2018
- Trait dissociation as a predictor of induced dissociation by ketamine or esketamine in treatment-resistant depression: Secondary analysis from a randomized controlled trial. Journal of Psychiatric Research May 8, 2021
and 9 more in the library