EPP005
Like Stepping Outside the Noise: Narrative Experiences of Esketamine-Induced Dissociation in Patients with Treatment-Resistant Depression
G. Versaci 1 2, M. Olivola 1 2 3, K. La Monica 1 2, M. C. Angeletti 1 2, V. Casati 1 2,*, A. Frediani 1 4, T. Prodi 1 2, F. Mazzoni 5, G. Miacca 5, A. Guffanti 5, N. Brondino 5, V. Martiadis 5, R. Anniverno 1 3, B. M. Dell'osso 1 2 6 7
1Mental Health Department, ASST Fatebenefratelli-Sacco, 2Biomedical and Clinical Sciences Department, University of Milan, 3Ospedale Macedonio Melloni, ASST Fatebenefratelli-Sacco, 4Mental Health Department, University of Milan, Milan, 5Mental Health Department, ASST Pavia, Pavia, Italy, 6Department of Psychiatry and Behavioral Sciences, Stanford University , Stanford, California, United States, 7Aldo Ravelli Center for Nanotechnology and Neurostimulation, University of Milan, Milan, Italy
Introduction: 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.
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Conclusions: In TRD patients, esketamine-induced dissociation can function as a liminal mental state that temporarily interrupts maladaptive self-processing. When framed within a supportive therapeutic context, these states may foster relief, insight, and psychological reorganization. Clinical protocols should incorporate psychoeducation and post-treatment reflection to optimize meaning-making and reduce distress.
Disclosure of Interest: None Declared