Esketamine Nasal Spray for Treatment-Resistant Bipolar II Depression: A Case Report
Psychiatry Investigation October 15, 2025 Hong-Ci Lin, Chia-Yu Chang, Ching-Huang Lin et al. 1 citation
A 62-year-old man with treatment-resistant bipolar II depression and hypertension showed improvement after adding esketamine nasal spray (ESK-NS) in October 2022, nearly remitting during the maintenance phase. However, depression recurred when ESK-NS frequency was reduced to once every 2 months, suggesting dosing frequency should be adjusted cautiously. Common side effects included dissociation, dizziness, and transient hypertension. Nifedipine was given when systolic blood pressure exceeded 160 mm Hg with headache or dizziness. Blood pressure monitoring was essential. This case highlights esketamine's potential for bipolar depression and calls for further studies on its cardiovascular effects and management.