Ketamine in Bipolar Disorder: A Review

Summary & key facts

This paper reviews research on using ketamine to treat bipolar disorder. The authors found early signs that low doses of ketamine can reduce depressive symptoms and suicidal thoughts very quickly, sometimes within hours or a day. Most studies are small or mix bipolar patients with other kinds of depression, so we do not yet know how well ketamine works long term or how safe it is specifically for people with bipolar disorder.

Key facts:

• Bipolar disorder affects more than 1% of people and has a high risk of suicide.
• Suicide causes about 15–20% of deaths in people with bipolar disorder.
• There are about 140 registered clinical trials of ketamine for psychiatric conditions, but fewer than 1% focus on bipolar disorder alone.
• Single low-dose ketamine given once into a vein has shown rapid antidepressant effects in controlled studies that included people with bipolar depression.
• One open study of 42 people with bipolar depression found that about half responded after a single ketamine infusion.
• A small study of 16 people with bipolar depression who received six low-dose infusions reported about 74% response and 63% remission one day after the last infusion.
• Larger studies that mixed bipolar and non-bipolar depression reported roughly 68% response and about 50% remission after multiple infusions, but those results were not broken down for bipolar patients alone.
• Ketamine often reduced suicidal thoughts quickly; one trial reported reduced suicidal thinking in about 57% of patients after the first infusion and about 65% after six infusions.
• Side effects in the reviewed studies were usually mild, but the risk that ketamine might trigger a manic episode (an affective switch) is not clear from current data.
• The exact brain processes by which ketamine works are not fully understood, so scientists do not yet know why it can act so fast.

Abstract

Abstract: Bipolar disorder (BD) is a psychiatric illness associated with high morbidity, mortality and suicide rate. It has neuroprogressive course and a high rate of treatment resistance. Hence, there is an unquestionable need for new BD treatment strategies. Ketamine appears to have rapid antidepressive and antisuicidal effects. Since most of the available studies concern unipolar depression, here we present a novel insight arguing that ketamine might be a promising treatment for bipolar disorder. Keywords: ketamine, bipolar disorder, staging, neuroprogression, treatment resistance

Topics

Bipolar Disorder and Treatment Treatment of Major Depression Tryptophan and brain disorders

Categories

Health Sciences Medicine Pharmacology

Tags

Bipolar disorder Cognition Depression (economics) Economics Ketamine Lithium (medication) Macroeconomics Major depressive disorder Medical emergency Medicine Poison control Psychiatry Suicide prevention Suicide rates Treatment-resistant depression

Substances

Ketamine

Conditions & symptoms

Depression Anxiety or worry Lack of energy or motivation Poor sleep Sadness or low mood