During intranasal esketamine treatment for treatment-resistant depression, patients describe four distinct types of dissociative experiences: sensory alteration and perceptual flow (27.8%), time suspension and chronological drift (58.3%), body and space alteration (55.6%), and psychic distance from suffering (83.3%). Most patients frame these experiences as neutral or meaningful, often linked to temporary relief from rumination and depressive distress, though a minority report transient distress or loss of control. The findings suggest dissociation functions as a transitional subjective state whose clinical relevance depends on anticipation, framing, monitoring, and integration, supporting structured psychoeducation and in-session support in esketamine programs.
Intranasal esketamine rapidly reduces suicidal ideation and depressive symptoms in patients with treatment-resistant depression. Suicidal ideation scores dropped from 1.56 at baseline to 0.78 after one week and to 0.12 after six months. Depressive symptoms improved from a mean Montgomery-Åsberg Depression Rating Scale score of 30.9 at baseline to 17.5 after one week and 9.8 after six months. Male gender was a negative predictor of response; no other baseline variable predicted outcomes. The findings suggest intranasal esketamine is effective for rapid reduction and resolution of suicidal ideation in this population, and gender differences should be considered in treatment planning.