Categorising “dissociation” as an AE for esketamine seems absurd – isn’t that exactly what the drug is meant to do? It would be interesting to study whether patients experiencing “dissociation” short-term have better or worse longer-term treatment outcomes. I’d be far more worried about long-term downsides, especially if patients after treatment manage to get their hands onto street ketamine. We had a ketamine ‘epidemic’ in the 2000s here in the UK, some use was purely recreational but a minority of people were using it to self-medicate against depression, often taking very large amounts on a daily basis. Some really bad outcomes, example here: https://www.vice.com/en/article/av4njj/ketamine-slowly-ruins-your-bladder-and-kills-you-863 I’m dismayed at how discussions about medical esketamine routinely ignore the vast body of experience – including clinical experience – amassed by ketamine users and professionals treating them in the UK in the 2000s.