Content area
Full text
A 42-year-old woman with refractory reflex sympathetic dystrophy developed prolonged mania, which was attributed to ketamine or an interaction between ketamine and duloxetine.
The woman was admitted for experimental IV ketamine therapy. She had a history of insomnia and depression, and was receiving duloxetine 20mg daily [route and duration of treatment not stated], quetiapine and mirtazapine, but these medications were stopped on admission. On hospital day 1, she commenced ketamine, which was titrated from 10 to 20 mg/hour over a 5-day period. Her pain initially improved, but worsened on day 2. Duloxetine 20mg and mirtazapine were resumed on day 3. Her pain improved thereafter....