Longitudinal Outcomes of Oral Glutamatergic Augmentation in Trauma-Related Dissociation: A Six-Month Case Study.

Résumé

Trauma-related dissociation can present with derealisation, depersonalisation, abrupt lapses in awareness, memory gaps, and fugue-like states, and it may be difficult to treat with standard approaches alone. Glutamatergic interventions have been proposed as neuroplasticity-focused strategies because N-methyl-D-aspartate (NMDA) receptor antagonism and downstream alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA)-linked signalling may influence synaptic plasticity. A 25-year-old woman with documented complicated grief related to her paternal grandfather's sudden death, longstanding derealisation, recurrent blank-outs, and fugue-like episodes presented with moderate depressive symptoms and moderate-to-severe anxiety. Over approximately seven months of documented outpatient psychiatric follow-up from 14 October 2025 to 4 May 2026, she was treated in an outpatient setting with an oral regimen consisting of dextromethorphan 30-60 mg/day, fluoxetine 10 mg/day, piracetam 600-1200 mg/day, and low-dose antipsychotic medication, with later medication adjustments according to tolerability and clinical response. Depressive symptoms improved gradually from moderate to mild severity. The most notable clinical change was the complete and sustained resolution of dissociative blank-outs and fugue-like states, accompanied by improved work performance, fewer unnoticed errors, and better self-monitoring. Generalized anxiety and relationship-triggered emotional reactivity improved only partially. Morning tiredness was reported early in treatment; however, the clinical record did not specify enough information to attribute this definitively to medication timing. This case suggests that oral NMDA-AMPA modulation may support progressive recovery of cognitive integration and functional capacity in trauma-related dissociation, while residual anxiety and interpersonal reactivity may require additional psychotherapeutic or targeted approaches. The case adds hypothesis-generating longitudinal support for low-cost glutamatergic augmentation in routine outpatient practice.