A report of affective switching associated with ketamine: The case of ketamine‐induced mania is not closed

<p>Ketamine in Bipolar Disorder: A Review</p>

“…There is mounting evidence for the beneficial effect of ketamine on synaptogenesis and neuroplasticity; such long-term effects are particularly interesting, considering the neuroprogressive nature of BD. [38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55]121 There is some evidence for the modifying effects of ketamine on epigenetic processes present in BD, [64][65][66][67][68][69][70] as well as its ability to regulate inflammation. [62][63][64][65][66][67][68][69] Ketamine may also have favorable effects on gut microbiota, which have been shown to be disturbed in patients with BD.…”

“…It is, therefore, possible that ketamine also has an antisuicidal effect which is independent of its antidepressive effect. 41,42…”

“…Current evidence suggests that the risk for affective switch is increased in patients treated with antidepressants, as well as in patients with a history of substance abuse, especially opioid use disorder. 41 Data from three studies, conducted among patients with treatment-resistant unipolar and bipolar depression, reported transient mood elevation in 7% and 10% of subjects administered placebo and subanesthetic doses of ketamine, respectively. As mood levels returned to baseline by the next day, the authors concluded that their results did not reflect a persistent substanceinduced syndrome.…”

Psychotic mania associated with topical ketamine in a patient with thoracic spine injury

“…Topical use has been described in the field of pain management. Ketamine is well‐known to induce psychotic symptoms; manic symptoms have been reported following intravenous administration in five cases, and one case of mania has been observed after chronic use of high‐dose inhaled ketamine . The mechanism by which ketamine exerts its mood‐altering and psychotogenic effects is unclear, though antidepressant effects are theorized to involve its NMDA receptor antagonism in addition to its effects on opioid or alpha‐amino‐3‐hydroxy‐5‐methyl‐4‐isoxazolepropionic acid (AMPA) receptors, or action through its metabolites.…”

Hypomania associated with high dose ketamine treatment

“…A growing number of psychiatrists, anesthesiologists, Certified Registered Nurse Anesthetists, and sometimes even emergency department physicians, are providing off-label infusions to patients for a wide range of diagnoses including bipolar depression, posttraumatic stress disorder, obsessive-compulsive disorder (OCD), chronic pain, cocaine dependency, and suicidality.Poorly monitored use of this medication for varied indications and in unusual dosing schedules and formulations is increasing, given the wide availability of ketamine and esketamine. 2,3 We present a case of high-dose ketamine associated with the development of hypomania in a patient with Bipolar II disorder (BPII), emphasizing the importance of the appropriate use of ketamine and the risk of treatment-emergent mania.…”