Esketamine Nasal Spray for Treatment-Resistant Bipolar II Depression: A Case Report
Hong-Ci Lin, Chia-Yu Chang, Ching-Huang Lin, Yung-Chih Chiang, Cheng-Ho Chang
Psychiatry Investigation October 15, 2025 DOI: 10.30773/pi.2024.0312 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Case report Peer reviewed |
|---|---|
| Sample size | 1 |
| Population | 62-year-old male with treatment-resistant bipolar II depression and hypertension |
| Intervention | Esketamine nasal spray |
| Topics | Depression Esketamine |
| Citations | 1 |
| Key findings | Esketamine nasal spray improved depressive symptoms in a patient with treatment-resistant bipolar II depression, but recurrence occurred when dosing frequency was reduced, and blood pressure monitoring was essential due to transient hypertension. |
Abstract
This case report discusses a 62-year-old male with treatment-resistant bipolar II depression and hypertension. After poor responses to multiple treatments, an add-on esketamine nasal spray (ESK-NS) was introduced in October 2022. Improvement was seen, and the patient's depressive episode was nearly remitted during the maintenance phase. However, recurrence was noted when ESK-NS frequency was reduced to once every 2 months, indicating that the dosing frequency should be adjusted cautiously. The patient experienced common side effects, including dissociation, dizziness, and transient hypertension. Nifedipine was offered when his systolic blood pressure exceeded 160 mm Hg, accompanied by headache or dizziness. Blood pressure monitoring was essential throughout ESK-NS treatment. This report highlights esketamine's potential for bipolar depression treatment and calls for further studies on its cardiovascular effects and proper management.
Comparable studies
Other case reports and case series on esketamine for depression, most cited first.