Like Stepping Outside the Noise: Narrative Experiences of Esketamine-Induced Dissociation in Patients with Treatment-Resistant Depression
G. Versaci, M. Olivola, K. La Monica, M. C. Angeletti, V. Casati, A. Frediani, T. Prodi, F. Mazzoni, G. Miacca, A. Guffanti, N. Brondino, V. Martiadis, R. Anniverno, B. M. Dell’ossoIntroduction
Esketamine-induced dissociation is a transient, pharmacologically mediated alteration in consciousness, often distinct from pathological dissociation. While not required for clinical improvement, these states may engage neural circuits implicated in therapeutic change.
Objectives
This study explores patients’ lived experiences of dissociation as potentially meaningful transitional states rather than adverse effects.
Methods
We conducted a qualitative, narrative-based study on 36 patients with treatment-resistant depression (TRD) treated with intranasal esketamine in Northern Italy (2022–2024). Patients provided detailed accounts of dissociative episodes during treatment. Narratives were anonymized and thematically analyzed, focusing on phenomenological dimensions: sensory alterations, temporal distortion, body–space reconfiguration, and emotional detachment from suffering.
Results
Four thematic domains emerged:
1. Sensory Intensification: Enhanced colors, synesthetic experiences, and altered auditory landscapes.
2. Temporal Distortion: Time dilation, loops, and present-centered awareness.
3. Body–Space Alteration: Weightlessness, out-of-body perspectives, and merging with surroundings.
4. Psychic Distance from Suffering: Temporary suspension of depressive thoughts and emotional pain.
Most participants described neutral-to-positive experiences, interpreting dissociation as peaceful, transformative, or offering a “pause” from suffering. A minority reported transient fear or disorientation, often mitigated by anticipatory guidance and post-session integration.
Image 1: Long description.