Dissociation is a sense of disconnection from yourself, your body, your surroundings or the flow of time. Mild forms are universal: losing track of a highway drive or getting absorbed in a book. Clinically significant dissociation includes depersonalization, feeling detached from your body or watching yourself from outside; derealization, where the world looks foggy, flat or unreal; and, in dissociative disorders, gaps in memory or identity. It is common in PTSD, panic disorder and borderline personality disorder, and it often traces back to overwhelming stress or trauma, when mentally stepping away was protective.
Dissociation also matters as a medication effect. Esketamine, the active ingredient in Spravato, causes temporary dissociation in a majority of patients, typically peaking about 40 minutes after the dose and resolving within an hour and a half. You might feel floaty, notice changes in how sounds or colors seem, or feel detached from the room. The experience is expected, monitored by staff, and not a sign that something is wrong. It is also one reason Spravato is given in a supervised clinic under the REMS program and why you cannot drive until the next day. When dissociation occurs outside of treatment and interferes with daily life, it deserves evaluation. Stedfast Psychiatry providers assess for trauma history, panic and dissociative disorders and treat the underlying condition, usually with trauma-focused therapy, grounding skills and, when indicated, medication.