The pattern of dissociative symptoms differs between post-traumatic stress disorder and first esketamine administration for treatment-resistant depression.

Dissociative symptoms are common in many patients with PTSD and also appear during the first esketamine treatment for treatment-resistant depression. Comparing 134 PTSD patients and 759 TRD patients receiving their first esketamine dose, dissociative symptoms were more prevalent overall in the esketamine group. However, the pattern differed: PTSD patients more often reported dissociative amnesia and identity fragmentation, while esketamine patients most frequently experienced depersonalization and derealization. This distinct pattern suggests that the underlying causes of dissociative symptoms may differ between these conditions.

Study at a glance

Abstract

Dissociative symptoms are commonly observed in a substantial minority of patients with Post-Traumatic Stress Disorder (PTSD) and during the first administration of esketamine for the treatment of Treatment-Resistant Depression (TRD). We examine differences in the number and pattern of dissociative symptoms (depersonalization, derealization, dissociative amnesia, identity fragmentation) reported by these two groups. Data for patients diagnosed with PTSD (N = 134) were drawn from studies of individuals with exposure to civilian traumas, childhood abuse or combat trauma. Data for patients with TRD undergoing their first treatment session with ESK (N = 759) were derived from published results detailing the presentation of dissociative symptoms during FDA registration trials. Dissociative symptoms in general were more prevalent in the ESK group (p < 0.01). However, a significant (p < 0.0001) Group x Item Domain interaction revealed that dissociative amnesia and identity fragmentation were endorsed more frequently relative to the other domains in the PTSD group relative to the ESK group. Depersonalization and derealization were the most prominent dissociative symptoms endorsed by the ESK group, whereas items from the dissociative amnesia domain were endorsed most frequently in the PTSD group. Groups differed in terms of demographics and duration of experienced dissociative symptoms; inability to examine potential impact of different esketamine doses. The pattern of dissociative symptoms endorsed by patients with PTSD differs from that reported by patients with TRD receiving esketamine for the first time, suggesting the possibility that the etiology of "dissociative symptoms" may vary across therapeutic conditions.