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

Gracja Ryznar; Katarzyna Bliźniewska-Kowalska; Piotr Gałecki

doi:10.5114/fpn.2025.159505

eISSN: 2449-9315
ISSN: 1234-8279

Pharmacotherapy in Psychiatry and Neurology/Farmakoterapia w Psychiatrii i Neurologii

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2/2025
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abstract:

Case report

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

Gracja Ryznar

¹

,

Katarzyna M. Bliźniewska-Kowalska

¹

,

Piotr Gałecki

¹

Department of Adult Psychiatry, Medical University of Lodz, Poland; Klinika Psychiatrii Dorosłych Uniwersytetu Medycznego w Łodzi, Łodź, Polska

Farmakoterapia w Psychiatrii i Neurologii 2025

DOI: https://doi.org/10.5114/fpn.2025.159505

Online publish date: 2026/04/28

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AMA

Ryznar G, Bliźniewska-Kowalska KM, Gałecki P. 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. Pharmacotherapy in Psychiatry and Neurology/Farmakoterapia w Psychiatrii i Neurologii. 2025;41(2):157-168. doi:10.5114/fpn.2025.159505.

APA

Ryznar, G., Bliźniewska-Kowalska, K. M.,  & Gałecki, P. (2025). 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. Pharmacotherapy in Psychiatry and Neurology/Farmakoterapia w Psychiatrii i Neurologii, 41(2), 157-168. https://doi.org/10.5114/fpn.2025.159505

Chicago

Ryznar, Gracja, Katarzyna M Bliźniewska-Kowalska,  and Piotr Gałecki. 2025. "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". Pharmacotherapy in Psychiatry and Neurology/Farmakoterapia w Psychiatrii i Neurologii 41 (2): 157-168. doi:10.5114/fpn.2025.159505.

Harvard

Ryznar, G., Bliźniewska-Kowalska, K.,  and Gałecki, P. (2025). 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. Pharmacotherapy in Psychiatry and Neurology/Farmakoterapia w Psychiatrii i Neurologii, 41(2), pp.157-168. https://doi.org/10.5114/fpn.2025.159505

MLA

Ryznar, Gracja et al. "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." Pharmacotherapy in Psychiatry and Neurology/Farmakoterapia w Psychiatrii i Neurologii, vol. 41, no. 2, 2025, pp. 157-168. doi:10.5114/fpn.2025.159505.

Vancouver

Ryznar G, Bliźniewska-Kowalska K, Gałecki P. 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. Pharmacotherapy in Psychiatry and Neurology/Farmakoterapia w Psychiatrii i Neurologii. 2025;41(2):157-168. doi:10.5114/fpn.2025.159505.

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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:

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

Gracja Ryznar 1 , Katarzyna M. Bliźniewska-Kowalska 1 , Piotr Gałecki 1

bipolar disorder, depression, psychotic symptoms, ketamine

Gracja Ryznar

¹

,

Katarzyna M. Bliźniewska-Kowalska

¹

,

Piotr Gałecki

¹