Induction of Prolonged Mania During Ketamine Therapy for Reflex Sympathetic Dystrophy
Biological Psychiatry May 6, 2011 Amy K. Ricke, R. Snook, A. Anand 34 citations
A 42-year-old woman with chronic pain from reflex sympathetic dystrophy, who was high-functioning despite high-dose opioid use, underwent experimental IV ketamine therapy. Her antidepressant and sleep medications were initially held. She reported immediate pain relief, but pain returned by day 2. After restarting two of her medications on day 3, she reported significant relief by day 4. Starting on day 7, she exhibited over-sedation, admitted to self-administering opioids from a hidden supply, and became irritable and emotionally labile. She detailed past traumas without prompting. Despite restarting quetiapine and increasing duloxetine, her symptoms worsened, including pressured speech and tangential, disorganized communication. The case suggests ketamine therapy may unmask or trigger mania-like symptoms in vulnerable individuals.