An Oral "Ketamine-Like" NMDA/AMPA Modulation Stack Restores Cognitive Capacity in a Young Man with Schizoaffective Disorder—Case Report
preprint DOI: 10.20944/preprints202511.2128.v1 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Case study Case report |
|---|---|
| Sample size | 1 |
| Population | 22-year-old man with schizoaffective disorder, bipolar type |
| Interventions | Deanxit (flupentixol 0.5 mg + melitracen 10 mg once-daily) dextromethorphan 15 mg twice-daily piracetam 600 mg twice-daily |
| Dose | Deanxit (flupentixol 0.5 mg + melitracen 10 mg once-daily); dextromethorphan 15 mg twice-daily; piracetam 600 mg twice-daily |
| Duration | Three months |
| Topics | Esketamine Ketamine |
| Key findings | A combination of Deanxit, dextromethorphan, and piracetam improved cognitive function in a patient with schizoaffective disorder, enabling academic completion and social engagement. |
Abstract
Cognitive impairment—rather than psychosis or mood instability—often drives long-term disability in schizoaffective disorder, yet current antipsychotic and mood-stabilising regimens offer little relief. We describe a 22-year-old man with schizoaffective disorder, bipolar type, whose persistent "brain fog" jeopardised university graduation despite euthymic mood and quiescent psychosis on lurasidone, olanzapine, and valproate. A mechanistically guided add-on protocol was introduced: Deanxit (flupentixol 0.5 mg + melitracen 10 mg once-daily) to provide mild serotonin–noradrenaline enhancement and moderate CYP2D6 inhibition; dextromethorphan 15 mg twice-daily to deliver gentle, σ₁-supported NMDA antagonism; and piracetam 600 mg twice-daily as a positive allosteric modulator of AMPA receptors. Within two weeks the patient reported clearer thinking and sustained reading; family noted coherent conversation and fewer attentional lapses. By six weeks he completed all coursework, passed mid-term examinations, and maintained social engagement—improvements never achieved with previous therapy. Benefits have persisted for three months with no mood destabilisation, psychotic relapse, or significant side-effects apart from transient nausea. We propose that melitracen's CYP2D6 blockade prolonged dextromethorphan exposure, enabling a steady NMDA "priming" signal, while piracetam amplified downstream AMPA throughput to consolidate synaptic plasticity. This case highlights the potential of inexpensive, orally available agents to target the NMDA–AMPA axis and alleviate the cognitive burden of schizoaffective disorder. Controlled trials are warranted.
Comparable studies
Other case reports and case series on ketamine, most cited first.