Esketamine Nasal Spray for Treatment-Resistant Bipolar II Depression: A Case Report
Psychiatry Investigation – October 15, 2025
Source: OpenAlex
Summary
Esketamine nasal spray showed promising results for a 62-year-old man with treatment-resistant bipolar II depression, achieving nearly complete remission during maintenance therapy. However, when the dosing frequency was reduced to once every two months, symptoms recurred, suggesting careful adjustment is crucial. Common side effects included dissociation and transient hypertension, with blood pressure exceeding 160 mm Hg managed by nifedipine. This case underscores esketamine's potential in treating major depression while emphasizing the need for monitoring cardiovascular effects and optimal dosing strategies.
Abstract
This case report discusses a 62-year-old male with treatment-resistant bipolar II depression and hypertension. After poor responses to multiple treatments, an add-on esketamine nasal spray (ESK-NS) was introduced in October 2022. Improvement was seen, and the patient's depressive episode was nearly remitted during the maintenance phase. However, recurrence was noted when ESK-NS frequency was reduced to once every 2 months, indicating that the dosing frequency should be adjusted cautiously. The patient experienced common side effects, including dissociation, dizziness, and transient hypertension. Nifedipine was offered when his systolic blood pressure exceeded 160 mm Hg, accompanied by headache or dizziness. Blood pressure monitoring was essential throughout ESK-NS treatment. This report highlights esketamine's potential for bipolar depression treatment and calls for further studies on its cardiovascular effects and proper management.