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Ketamine-Induced Mania During Treatment for Complex Regional Pain Syndrome

Mala C. Mandyam, Neera K. Ahuja

Pain Medicine March 10, 2017 DOI: 10.1093/pm/pnx061 (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 30-year-old woman with complex regional pain syndrome of the right lower extremity and depression
Intervention Ketamine
Topics Esketamine Ketamine
Citations 10
Key findings The authors report that a ketamine infusion for CRPS in a young woman with depression induced a prolonged manic episode and may have unmasked bipolar disorder. They note that few other case reports have documented similar prolonged exacerbations of underlying mood disorders after ketamine administration.

Abstract

Dear Editor, Complex regional pain syndrome (CRPS) describes a disease of localized chronic pain that often occurs after preceding trauma, is out of proportion to its expected course, and includes other symptoms such as hair loss and allodynia [1]. There are no known psychologic or personality factors associated with its development [2]. Therapy is multimodal, and pharmacologic treatments include steroids, antiepileptics, antidepressants, opiates, and ketamine [3]. Ketamine is mainly an N-methyl-D-aspartate (NMDA) receptor antagonist with known psychomimetic effects that are usually transient, mild, and tolerable [4]. We describe a case of ketamine inducing a prolonged manic episode and potentially unmasking bipolar disorder in a young woman with depression and CRPS. Few other case reports have documented similar prolonged exacerbations of underlying mood disorders post–ketamine administration. Our patient is a 30-year-old female who was admitted to the inpatient pain service for ketamine infusion for right lower extremity CRPS. She sustained a right foot sprain during laser tag three years prior. She developed constant pain that was aggravated by touch, temperature changes, and humidity. She tried physical therapy, group psychotherapy, pregabalin, mexiletine, gabapentin, and an epidural injection with little effect. Intravenous (IV) lidocaine previously provided only temporary relief, and a spinal cord stimulator failed after six weeks. Opiates previously helped, but she developed opioid use disorder, for which she was undergoing treatment.

Comparable studies

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

Study Year Design Participants
The destruction of the lower urinary tract by ketamine abuse: a new syndrome? Young recreational abusers of street-ketamine in Hong Kong referred to urology units 2008 Retrospective case series n = 59
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
Treatment of compulsive behaviour in eating disorders with intermittent ketamine infusions Chronic and treatment-resistant eating disorder patients 1998 Case series n = 15
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

Citations in the library

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Cites 2

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Esketamine Ketamine Addiction Depression