[Ketamine in melancholic depression]

Area of Science:

• Neuroscience
• Psychiatry
• Pharmacology

Background:

• Bipolar disorder is a serious mental health condition often associated with severe depressive episodes and increased suicide risk.
• Major depression with melancholic and nihilistic features presents a significant treatment challenge.
• Electroconvulsive therapy (ECT) is an effective treatment but requires preparation and may not offer immediate relief.

Observation:

• A 35-year-old male with bipolar disorder presented with severe depression and suicidal ideation following an attempt.
• The patient exhibited melancholic symptoms and nihilistic delusions, indicating a critical state.
• Immediate intervention was necessary to mitigate suicide risk and alleviate profound suffering.

Findings:

• Administration of S-ketamine at 0.5 mg/kg resulted in a rapid reduction of the patient's depressive symptoms and suicidal agony.
• The therapeutic effects of S-ketamine were observed within two hours post-administration.
• Symptomatic improvement was sustained and measurable for a period of five days.

Implications:

• S-ketamine demonstrates potential as a rapid-acting agent for managing acute suicidal crises in bipolar disorder.
• This finding suggests S-ketamine may serve as a valuable adjunctive therapy in the interim period before other treatments like ECT become fully effective.
• Further research into S-ketamine's efficacy and safety profile for severe mood disorders is warranted.