A woman with borderline personality disorder and treatment-resistant depression improved after taking very low doses of ketamine under the tongue. Ketamine, typically given intravenously, has shown rapid antidepressant effects and can also reduce borderline personality disorder symptoms when given repeatedly through a vein. A single previous case reported improvement with intranasal esketamine. This case suggests that very low-dose sublingual ketamine may be an effective treatment for psychiatric conditions like borderline personality disorder and co-occurring treatment-resistant depression.
A 75-year-old man with chronic exploding head syndrome—loud internal noises, lightning-like sensations, and sleep paralysis for over five years—failed multiple standard medications. Sublingual ketamine, starting at 25 mg every third night and increasing to nightly, reduced episodes from 3-4 times weekly to once every two weeks after one month, monthly by three months, and resolved completely by six months, with only occasional sleep paralysis remaining. The treatment improved quality of life. Ketamine may work through NMDA receptor modulation and neuroplasticity. This case suggests a potential new approach for this difficult-to-treat sleep disorder.