Rapid reduction of suicidal ideation with transient dissociative and "drunken gait" symptoms after intranasal esketamine, with music intervention: a case report.
Haihua Tian, Zongfeng Zhang, Yan He, Yuqiu Su, Xiaofeng Zhu, Yuhong Ding, Haihang Yu, Liuyin Jin, Jimeng Liu
Frontiers in psychiatry January 1, 2026 Peer reviewed DOI: 10.3389/fpsyt.2026.1739904 via PubMed
Summary
Intranasal esketamine effectively alleviated depressive symptoms and resolved suicidal ideation in a 19-year-old woman with treatment-resistant depression after two treatment courses. During the first course, she experienced transient dissociative symptoms and a 'drunken gait,' which were manageable with patient-selected music and prophylactic oxazepam. The second treatment course proceeded without issues, highlighting esketamine's potential as a rapid intervention for TRD, especially in patients at risk of suicide.
Study at a glance
| Design | case study |
|---|---|
| Sample size | 1 |
| Population | a 19-year-old woman with treatment-resistant depression and prior suicide attempts |
| Key finding | Intranasal esketamine led to rapid improvement of depressive symptoms and resolution of suicidal ideation, with manageable dissociative side effects. |
Abstract
Treatment-resistant depression (TRD) is often accompanied by persistent suicidal ideation and poor response to conventional antidepressants. Intranasal esketamine, a non-selective NMDA receptor antagonist, provides rapid antidepressant and anti-suicidal effects; transient dissociation is common, whereas ataxia-like "drunken gait" is rarely described. A 19-year-old woman with recurrent depression and multiple prior suicide attempts received two courses of intranasal esketamine (56 and 84 mg, twice weekly for four weeks each). During the first course, she developed transient dissociative symptoms lasting approximately 55 minutes, predominantly characterized by depersonalization and accompanied by a "drunken gait. Under supervision, patient-selected music promptly reduced anxiety and disorientation, improving tolerability. From week 2, prophylactic oxazepam 25 mg prevented mild delayed dissociative episodes. The second course was uneventful. By the end of treatment, suicidal ideation had resolved. This case illustrates rapid improvement of depressive symptoms and suicidality with esketamine and shows that dissociative reactions are typically self-limiting and manageable. Music intervention may attenuate these experiences by modulating prefrontal-amygdala circuits and autonomic regulation, thereby reducing anxiety and enhancing reality orientation. Individualized monitoring and psychological support are recommended components of esketamine services. Intranasal esketamine is a promising option for TRD with elevated suicide risk. Patient-selected music is a feasible adjunct to manage dissociative side effects and may improve safety and adherence. Further research should clarify mechanisms and long-term safety.