Add-on Subanesthetic Ketamine in Electroconvulsive Therapy: A Case Report of a Patient with Bipolar Depression

A 57-year-old successful businessman patient experienced his first major depressive episode at the age of 42 years. During the age of 43–45 years, he had an elevated mood, during which he had had a buying spree having spent about 100 million New Taiwan dollars in three years. He retained occupational function during that time, and the hypomanic condition was remitted spontaneously. After that, he remained in a persistent dysphoric state for 10 years, and he retired from his job at 50 years of age. He had his second major depressive episode when he was 55 years old, and he attempted suicide with a drug overdose. His third major depressive episode began at the end of 2018. The symptoms and signs included all-day depressive mood, loss of interest, intense anxiety, poor appetite with bodyweight loss, insomnia, low motivation with poor energy, psychomotor retardation, and attempted suicide with another drug overdose again in June 2019. He was then admitted to our psychiatric inpatient ward.