Short term ketamine treatment in patient with bipolar disorder with comorbidity with borderline personality disorder: Focus on impulsivity
Maria Gałuszko‐węgielnik, Katarzyna Jakuszkowiak‐wojten, Alina Wilkowska, Wiesław Jerzy Cubała
The World Journal of Biological Psychiatry June 20, 2023 DOI: 10.1080/15622975.2023.2227901 via OpenAlex
Summary
A woman with both bipolar disorder and borderline personality disorder received intravenous ketamine for acute depression. While ketamine initially improved her depressed mood, continued treatment led to increased nonsuicidal self-injury, impulsive behavior, and worsening dissociative symptoms. Treatment was stopped and replaced with a different medication that proved helpful. The authors conclude that ketamine's effects on emotional dysregulation and impulsivity are unclear and differ from its antidepressant effects, highlighting the need for more safety and effectiveness studies in this patient group.
Study at a glance
| Characteristics | Case study Case report Peer reviewed |
|---|---|
| Sample size | 1 |
| Population | Female patient diagnosed with both bipolar disorder and borderline personality disorder |
| Intervention | Intravenous ketamine |
| Topics | Anxiety Depression Ketamine |
| Keywords | Borderline personality disorder Impulsivity Bipolar disorder Antidepressant |
| Citations | 9 |
| Key finding | Ketamine initially improved depressive symptoms but later led to increased nonsuicidal self-injury, impulsive behavior, and worsening dissociative symptoms in a patient with comorbid bipolar disorder and borderline personality disorder. |
Abstract
OBJECTIVES: Borderline personality disorder (BPD) and bipolar disorder (BD) often co-occur and frequently do not respond adequately to traditional antidepressant treatments. Ketamine has shown rapid antidepressant and anti-suicidal effects. However, there is limited literature on the safety and tolerance of using ketamine to treat patients with comorbid BD and BPD. METHODS: This case presents a female patient diagnosed with both Bipolar Disorder (BD) and Borderline Personality Disorder (BPD) who received intravenous ketamine treatment to alleviate acute depressive symptoms. RESULTS: Initially, ketamine ameliorated depressed symptoms. However, as the ketamine treatment continued, the patient showed an increase in nonsuicidal self-injury (NSSIs) and impulsive conduct with a aggravation of dissociative symptoms. As a result, intravenous ketamine was discontinued, and the patient received the medication, which proved helpful. CONCLUSIONS: Although ketamine presents antidepressant properties, reports on its impact on emotional dysregulation and impulsive conduct are unclear and not alike to its antidepressant effect. Therefore, there is a need for more studies investigating the effectiveness and safety of this rapid-acting medicine in this patient population.