Inclusion Criteria:  Males and Females Age 14 - 40 years Clinical diagnosis of Bipolar Disorder -Fear of Harm Phenotype Meets Papolos criteria for FOH based on independent interviews. Taking intranasal ketamine for at least 2 months. Must be on an every three or every four-day dosing regimen Dosage will not exceed 300 mg per dosing interval. Willing to delay ketamine dose by 2 days past their prescribed dosing interval Prior experience having tolerated this degree of delay. Willing to participate in daily assessments during period of ketamine withdrawal prior to traveling to Belmont ,MA. Willing to provide urine sample to screen for drugs of abuse (all participants and pregnancy in females.)  Exclusion Criteria:  Any psychiatric hospitalization within the past 6 months Lifetime history of suicide attempts Co-occurring substance use disorders Any change in concomitant medications within the last 2 months