Esketamine Nasal Spray for Treatment-Resistant Bipolar II Depression: A Case Report

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.