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Attenuation of severe ketamine-induced neuropsychiatric side effects by lamotrigine in a patient with treatment resistant bipolar depression: A case report

Brian S. Barnett, Amit Anand

Psychiatry Research Case Reports August 20, 2023 DOI: 10.1016/j.psycr.2023.100167 (opens in new tab)

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Study at a glance

AI-extracted from the abstract
Characteristics Case study Case report Peer reviewed
Sample size 1
Population Patient with treatment resistant bipolar depression
Interventions Lamotrigine Ketamine
Topics Ketamine Depression Esketamine
Keywords Lamotrigine Discontinuation Depression economics Tolerability Bipolar disorder Anesthesia Adverse effect Mood Epilepsy
Key findings Lamotrigine pre-treatment may prevent severe neuropsychiatric side effects from ketamine in patients with bipolar depression.

Abstract

Though usually mild, neuropsychiatric side effects of intravenous ketamine for depression occasionally result in treatment discontinuation. Two small clinical trials of healthy subjects have indicated that lamotrigine pre-treatment may attenuate these side effects, though two other trials, one in patients with unipolar depression and one in healthy male volunteers, did not support these findings. While case reports and observational studies have documented successful treatment of patients with bipolar depression receiving lamotrigine and ketamine, none have reported on cessation of neuropsychiatric side effects from ketamine after lamotrigine initiation in this patient population. Here we present the case of a patient with treatment resistant bipolar depression successfully pre-treated with lamotrigine to prevent previously experienced severe neuropsychiatric side effects from ketamine. She tolerated the ketamine infusion well and her depressed mood improved rapidly. This case suggests that concurrent treatment with lamotrigine may present an effective tolerability improvement strategy for patients with bipolar depression who have previously experienced neuropsychiatric side effects from ketamine.

Comparable studies

Other case reports and case series on ketamine for depression, most cited first.

Study Year Design Participants
Electroconvulsive Therapy, Ketamine, and Esketamine in a Patient with Major Depressive Disorder and Multiple Comorbidities: A Case Report over 10-year Treatment from Adolescence to Adulthood. A patient with treatment-resistant depression and comorbid generalized anxiety... 2025 Case report n = 1
Oral Administration of the NMDA Receptor Antagonist S-Ketamine as Add-On Therapy of Depression: A Case Series Four depressed patients taking standard antidepressants 2009 Case series n = 4
A longitudinal case series of IM ketamine for patients with severe and enduring eating disorders and comorbid treatment‐resistant depression Patients with enduring eating disorders and treatment-resistant depression 2021 Case series n = 4
Effects of intranasal (S)-ketamine on Veterans with co-morbid treatment-resistant depression and PTSD: A retrospective case series Veterans with co-morbid depression and PTSD 2022 Retrospective case series n = 35
Case report: Intramuscular ketamine or intranasal esketamine as a treatment in four patients with major depressive disorder and comorbid anorexia nervosa Patients with anorexia nervosa and a comorbid depressive disorder treated at a private... 2023 Case report n = 4

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