Intravenous Ketamine-induced Affective Switch in a Patient of Major Depressive Disorder with Suicidal Ideation: A Case Report
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https://doi.org/10.55229/ijbs.v25i2.14Keywords:
Major Depressive Disorder, Suicidal ideation, Intravenous, Ketamine, Treatment-emergent affective switchDimensions Badge
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Copyright (c) 2022 Akanksha Varshney, Shravan Kumar, Ved Prakash Gupta, Rehan Mateen, Suhail Ahmad Azmi

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In treatment-resistant unipolar and bipolar depression, there is increasing evidence to support the fast, although the short-lived antidepressant effect of ketamine, a non-competitive glutamate N-methyl-D-aspartate receptor antagonist. Ketamine has been shown to cause transient mood elevation or euphoria, dissociative symptoms and psychotomimetic effects when administered in unipolar or bipolar depression. Still, it has not been shown to cause an affective switch resulting in persistent hypomania/mania or a manic-like state. We report the case of a 47-year-old man who developed a switch to mania while receiving a sub-anaesthetic dosage of ketamine intravenously for his third episode of recurrent, non-psychotic severe major depression with suicidal ideation. This case indicates that a polarity switch should be acknowledged as a possible side effect when using ketamine for depression.Abstract
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Naughton M, Clarke G, O'Leary OF, Cryan JF, Dinan TG. A review of ketamine in affective disorders: Current evidence of clinical efficacy, limitations of use and pre-clinical evidence on proposed mechanisms of action. J Affect Disord 2014;156:24-35. Serafini G, Howland RH, Rovedi F, Girardi P, Amore M. The role of ketamine in treatment-resistant depression: A systematic review. Curr Neuropharmacol 2014;12:444-61. Tohen M, Frank E, Bowden CL, Colom F, Ghaemi SN, Yatham LN, et al. The International Society for Bipolar Disorders (ISBD) Task Force report on the nomenclature of course and outcome in bipolar disorders. Bipolar Disord 2009;11:453-73. Wada K, Sasaki T, Jitsuiki H, Yoshimura Y, Erabi H, Hada Y, et al. Manic/hypomanic switch during acute antidepressant treatment for unipolar depression. J Clin Psychopharmacol 2006;26:512-5. Navarro V, Gastó C, Guarch J, Penadés R, Pintor L. Treatment and outcome of antidepressant treatment-associated hypomania in unipolar major depression: A 3-year follow-up study. J Affect Disord 2014;155:59-64. Niciu MJ, Luckenbaugh DA, Ionescu DF, Mathews DC, Richards EM, Zarate CA Jr. Subanesthetic dose ketamine does not induce an affective switch in three independent samples of treatment-resistant major depression. Biol Psychiatry 2013;74:e23-4. Ricke AK, Snook RJ, Anand A. Induction of prolonged mania during ketamine therapy for reflex sympathetic dystrophy. Biol Psychiatry 2011;70:e13-4. Niciu MJ, Luckenbaugh DA, Ionescu DF, Mathews DC, Richards EM, Zarate CA Jr. Subanesthetic Dose Ketamine Does Not Induce an Affective Switch in Three Independent Samples of Treatment-Resistant Major Depression. Biol Psychiatry (2013) 15(74(10)):e23–4. doi: 10.1016/j.biopsych.2013.01.038. Banwari G, Desai P, Patidar P. Ketamine-induced affective switch in a patient with treatment-resistant depression.Indian J Pharmacol 2015;47:454-455.
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