Bipolar disorder is a psychiatric illness with high morbidity, mortality, and suicide rates, a neuroprogressive course, and frequent treatment resistance, creating a need for new treatment strategies. Ketamine appears to have rapid antidepressive and antisuicidal effects. Because most available studies concern unipolar depression, this article presents a novel argument that ketamine might be a promising treatment for bipolar disorder.
Ketamine can rapidly reduce depression in people with treatment-resistant bipolar disorder, but it also carries a risk of triggering mania. This case describes a patient with bipolar I disorder who, after eight low doses of oral ketamine added to their usual treatment, switched from a depressive episode to a manic episode with mixed features. The manic symptoms began two days before the switch became full-blown. The finding highlights the need for careful monitoring of mood changes when using ketamine in bipolar depression.