Bridging Nonconsecutive Esketamine Weeks with Bupropion and Over-the-Counter Dextromethorphan.
Richard Colby, Thomas Schwartz
✦ AI-curated · Sources linked
Case in brief
A 52-year-old woman with treatment-resistant depression and bipolar II disorder achieved remission with weekly intranasal esketamine, but depressive symptoms returned when sessions were more than 10 days apart. Her PHQ-9 fell from 27 at baseline to 4 (±1) during maintenance and could rise by as many as 8 points after a delayed session. While continuing bupropion XL 450 mg daily, she added over-the-counter dextromethorphan 45 mg twice daily for one week between esketamine doses. She remained free of depressive relapse on esketamine every 14 days with this bridging regimen.
What made this case unusual
The report describes using over-the-counter dextromethorphan alongside ongoing bupropion to bridge the gap between nonconsecutive esketamine sessions, allowing this patient to extend maintenance dosing to every 14 days without reported relapse.
Diagnostic / clinical pearl
In this individual case, depressive symptoms recurred when esketamine intervals exceeded 10 days; dextromethorphan with ongoing bupropion was associated with stability during every-other-week dosing. This is a case observation, not evidence of efficacy in other patients.