Abstract
Potentiation of antidepressant treatment with racemic ketamine in a patient with an episode of severe depression in the course of bipolar disorder (BD) and a positive history of psychotic mania – a case report
- Department of Adult Psychiatry, Medical University of Lodz, Poland; Klinika Psychiatrii Dorosłych Uniwersytetu Medycznego w Łodzi, Łodź, Polska
Objectives
Although ketamine has become standard treatment for unipolar depression, particularly drug-resistant depression, its use for bipolar depression requires careful consideration of potential benefits and risks, especially in patients with a history of psychotic symptoms.
Case report
In a 52-year-old man with BD, the depressive episode was severe and showed no satisfactory improvement despite multiple changes to pharmacotherapy; therefore, augmentation with intravenous racemic ketamine was considered. However, concern was raised because the patient had experienced a severe manic episode with psychotic features seven years earlier. The patient received racemic ketamine.
Conclusions
A prior history of manic episodes or psychotic symptoms in BD should not automatically preclude ketamine treatment; however, a detailed, individualised risk assessment is essential in each case.
Keywords
bipolar disorder, depression, psychotic symptoms, ketamine
Integrated with
