Longitudinal Outcomes of Oral Glutamatergic Augmentation in Trauma-Related Dissociation: A Six-Month Case Study.
Cureus May 1, 2026 DOI: 10.7759/cureus.108751 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Case study Longitudinal Case report Peer reviewed |
|---|---|
| Sample size | 1 |
| Population | 25-year-old woman with trauma-related dissociation and complicated grief |
| Interventions | dextromethorphan fluoxetine piracetam low-dose antipsychotic |
| Dose | 30-60 mg/day |
| Duration | Approximately seven months of outpatient follow-up from 14 October 2025 to 4 May 2026 |
| Topics | PTSD |
| Keywords | Cheung regimen Dissociative fugue Dxm Glutamatergic Trauma |
| Key findings | Complete and sustained resolution of dissociative blank-outs and fugue-like states occurred with a dextromethorphan-based glutamatergic regimen. |
Abstract
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 alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA)-linked signalling may influence synaptic plasticity. A 25-year-old woman with documented complicated grief related to her paternal grandfather's sudden death, longstanding derealisation, recurrent blank-outs, and fugue-like episodes presented with moderate depressive symptoms and moderate-to-severe anxiety. Over approximately seven months of documented outpatient psychiatric follow-up from 14 October 2025 to 4 May 2026, she was treated in an outpatient setting with an oral regimen consisting of dextromethorphan 30-60 mg/day, fluoxetine 10 mg/day, piracetam 600-1200 mg/day, and low-dose antipsychotic medication, with later medication adjustments according to tolerability and clinical response. Depressive symptoms improved gradually from moderate to mild severity. The most notable clinical change was the complete and sustained resolution of dissociative blank-outs and fugue-like states, accompanied by improved work performance, fewer unnoticed errors, and better self-monitoring. Generalized anxiety and relationship-triggered emotional reactivity improved only partially. Morning tiredness was reported early in treatment; however, the clinical record did not specify enough information to attribute this definitively to medication timing. This case suggests that oral NMDA-AMPA modulation may support progressive recovery of cognitive integration and functional capacity in trauma-related dissociation, while residual anxiety and interpersonal reactivity may require additional psychotherapeutic or targeted approaches. The case adds hypothesis-generating longitudinal support for low-cost glutamatergic augmentation in routine outpatient practice.
Comparable studies
Other case reports and case series on PTSD, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Combining Cognitive-Behavioral Conjoint Therapy for PTSD with 3,4-Methylenedioxymethamphetamine (MDMA): A Case Example. One couple with PTSD and a severe trauma history, participating in a pilot trial... | 2019 | Case study | n = 2 |
| Effects of intranasal (S)-ketamine on Veterans with co-morbid treatment-resistant depression and PTSD: A retrospective case series Veterans with co-morbid depression and PTSD | 2022 | Retrospective case series | n = 35 |
| Repeated oral esketamine in patients with treatment resistant depression and comorbid posttraumatic stress disorder Patients with treatment-resistant depression and comorbid PTSD | 2023 | Case series | n = 5 |
| Treatment of nightmares in the context of posttraumatic stress disorder A client with chronic, severe posttraumatic stress disorder (PTSD) | 2010 | Case study | n = 1 |
| 5-MeO-DMT for post-traumatic stress disorder: a real-world longitudinal case study 23-year-old female with chronic refractory PTSD | 2023 | Case study | n = 1 |
Citations in the library
Cites 6
- A Randomized Controlled Trial of Repeated Ketamine Administration for Chronic Posttraumatic Stress Disorder. American Journal of Psychiatry January 5, 2021
- Long term structural and functional neural changes following a single infusion of Ketamine in PTSD Neuropsychopharmacology June 3, 2023
- DXM, CYP2D6-inhibiting antidepressants, piracetam, and glutamine: proposing a ketamine-class antidepressant regimen with existing drugs. Frontiers in Psychiatry 2026
- Dextromethorphan-bupropion (Auvelity) for the Treatment of Major Depressive Disorder Clinical Psychopharmacology and Neuroscience July 17, 2023
- Involvement of AMPA receptor in both the rapid and sustained antidepressant-like effects of ketamine in animal models of depression. Behavioural Brain Research June 6, 2011
and 1 more in the library