title: Ketamine and transcranial magnetic stimulation treatment for bipolar II disorder: a case report.
abstract: BACKGROUND
  To the best of our knowledge, this is the first case report of successful treatment for bipolar II disorder using a combined ketamine and transcranial magnetic stimulation treatment.
  
  
  METHODS
  A 43-year-old Caucasian unemployed man presented to us with treatment-resistant bipolar II disorder, currently in a mixed state. A psychometric assessment and brain single-photon emission computer tomography scan were conducted at baseline. His psychometric assessment revealed severe depressive and manic symptoms that were consistent with bipolar II disorder. Findings from a brain single-photon emission computer tomography scan converged with those from his psychometric assessment. The combined ketamine and transcranial magnetic stimulation treatment was administered a total of 24 times over five months, with his ketamine dosage increased from 50mg at the first treatment to 600 mg by the last. Starting after the second treatment, he reported substantial improvements in his symptoms. A follow-up psychometric assessment and brain single-photon emission computer tomography scan five months later revealed substantial blood flow increases in the previously deficient areas.
  
  
  CONCLUSIONS
  We provide preliminary evidence for a treatment method that magnifies the therapeutic benefits of infused ketamine along with transcranial magnetic stimulation. We postulate that this may be based on an interaction at the level of the relevant cortico-thalamo-cortical circuit(s).
authors.affiliation: The Neuroscience Center, 440 Lake Cook Road, Building 2, Deerfield, IL, 60015, USA. srdbest@neuroscience.md.
authors.forename: Steven R D
authors.initials: SR
authors.lastname: Best
authors.affiliation: Independent Practice, 333 East Ontario Suite 1203B, Chicago, IL, USA. blotdoc@aol.com.
authors.forename: Brian P
authors.initials: BP
authors.lastname: Griffin
authors.affiliation: PathFinder Brain SPECT, 440 Lake Cook Road, Suite 3, Deerfield, IL, 60015, USA. danpavel@yahoo.com.
authors.forename: Dan G
authors.initials: DG
authors.lastname: Pavel
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000628:therapy*; D001921:Brain / Q000502:physiology; D003131:Combined Modality Therapy; D006801:Humans; D007649:Ketamine / Q000627:therapeutic use*; D008297:Male; D011594:Psychometrics; D016194:Receptors, N-Methyl-D-Aspartate / Q000037:antagonists & inhibitors*; D015899:Tomography, Emission-Computed, Single-Photon; D050781:Transcranial Magnetic Stimulation / Q000379:methods*
chemical_list: D016194:Receptors, N-Methyl-D-Aspartate; D007649:Ketamine