Intranasal esketamine as tool for rapid cycling bipolar disorder: A case report of successful mood stabilization
Giacomo D’andrea, Ornella di Marco, Francesco Maria Semeraro, Rosalba Carullo, Stefano L. Sensi, Mauro Pettorruso, Giovanni Martinotti
Psychiatry Research Case Reports October 18, 2023 DOI: 10.1016/j.psycr.2023.100188 via OpenAlex
Summary
AI-generated from the abstractA 56-year-old man with rapid cycling bipolar disorder, experiencing four or more mood episodes per year, received esketamine nasal spray during a depressive episode and was followed for 18 months. He showed substantial mood stabilization, with only a brief depressive episode when treatment was stopped for three months, which resolved after restarting esketamine. Mild dissociative symptoms occurred with initial doses, but no other serious side effects were reported. This case suggests esketamine nasal spray may have mood-stabilizing effects for rapid cycling bipolar disorder, a condition that often responds poorly to lithium and standard treatments.
Study at a glance
| Characteristics | Case report Peer reviewed |
|---|---|
| Sample size | 1 |
| Population | 56-year-old male diagnosed with rapid cycling bipolar disorder |
| Intervention | Esketamine nasal spray |
| Duration | 18-month follow-up |
| Topics | Depression |
| Keywords | Hypomania Bipolar disorder Context archaeology Depression economics Mood |
| Citations | 1 |
| Key finding | Esketamine nasal spray was associated with mood stabilization over 18 months in a patient with rapid cycling bipolar disorder, with a transient depressive episode during a three-month treatment pause that resolved upon resuming therapy. |
Abstract
Rapid Cyclic Bipolar Disorder (RCBD) is a debilitating condition that manifests as four or more episodes of depression, mania, or hypomania in a span of one year, with depression being the predominant event. RCBD is prevalent among individuals diagnosed with bipolar disorder and is associated with elevated suicide risk, prolonged disease duration, unfavorable clinical outcomes, and cognitive decline. The treatment of RCBD is challenging, owing to the poor response to lithium and other conventional treatments for bipolar disorder and the possibility of exacerbating rapid-cycling oscillations during depressive phases with the use of antidepressant therapies. Esketamine Nasal Spray (ESK-NS) has been approved for the treatment of Treatment-Resistant Depression but its application in the context of RCBD is limited and unknown. This study presents the case of a 56-year-old male diagnosed with RCBD who received ESK-NS treatment during a depressive episode and was followed up for 18 months. During the observation period, the subject exhibited a significant mood stabilization, with only a transient depressive episode observed during a three-month period of cessation of ESK-NS treatment, which promptly resolved upon reinstating ESK-NS therapy. Mild dissociative symptoms were observed during the initial doses of ESK-NS administration, but no other significant adverse events were reported. This case report provides initial evidence for the potential utilization of ESK-NS in the treatment of RCBD, supporting the hypothesis of an additional mood-stabilizing effect.