Managing dissociative symptoms following the use of esketamine nasal spray: a case report
Sophia Pereira, Emily Brennan, Anjali Patel, Melissa Moran, Jenny Wallier, Michael R. Liebowitz
International Clinical Psychopharmacology 2021 DOI: 10.1097/yic.0000000000000327 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Case study Case report Peer reviewed |
|---|---|
| Sample size | 1 |
| Population | A 64-year-old woman with major depressive disorder and treatment-resistant depression enrolled in a clinical trial |
| Intervention | Esketamine nasal spray |
| Dose | 56 mg of esketamine nasal spray (two nasal spray devices, 28 mg per device); flexible doses of 56 or 84 mg twice weekly |
| Duration | Twice weekly for 4 weeks |
| Topics | Esketamine |
| Key findings | The patient experienced a 40-minute dissociative episode with anxiety and confusion 20 minutes after receiving 56 mg of esketamine nasal spray. Listening to music of her choice during treatment sessions, along with staff reassurance, was associated with notable improvement in her symptoms. The authors propose that this nonpharmacologic approach may help manage dissociation-related anxiety and confusion after esketamine administration. |
Abstract
Patients with treatment-resistant depression (TRD) treated with esketamine nasal spray commonly experience transient symptoms of dissociation. Manifestations of dissociation, such as feelings of detachment from the environment, can cause considerable anxiety for patients. Nonpharmacologic interventions may help clinicians to manage associated anxiety and confusion due to dissociation following administration of esketamine nasal spray. We present the case of a 64-year-old woman with major depressive disorder who participated in a clinical trial evaluating the efficacy and safety of esketamine nasal spray in conjunction with an oral antidepressant for TRD. The patient received flexible doses of esketamine nasal spray (56 or 84 mg) twice weekly for 4 weeks. On treatment day 1, the patient was administered 56 mg of esketamine nasal spray using two nasal spray devices (28 mg per device). Twenty minutes after the first esketamine nasal spray device was administered, the patient experienced a dissociative episode lasting 40 minutes that caused anxiety and confusion. The patient was encouraged to listen to music during treatment sessions, which resulted in notable improvement of her symptoms. Listening to music of choice immediately following esketamine nasal spray administration along with reassurance from staff may help manage confusion and anxiety associated with dissociation.
Comparable studies
Other case reports and case series on esketamine, most cited first.