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Mania, a psychological condition characterized by elevated mood, increased energy, and reduced sleep need, is part of the bipolar disorder cycle. The exact cause of mania isn't entirely known, but it is thought to be a combination of genetic, environmental, and neurological factors. Bipolar disorder involves alternating manic and depressive episodes. Mood stabilizers like lithium, antipsychotics, and anticonvulsants help manage these episodes. Lithium carbonate is particularly effective as...
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The elimination half-life and drug clearance of drugs following nonlinear kinetics can vary with dosage. The Michaelis-Menten parameters and drug concentration influence these factors. As the dose increases, the elimination half-life tends to lengthen, resulting in a reduction in clearance and a disproportionately larger area under the curve. The total clearance can be derived from the Michaelis-Menten equation for drugs following a one-compartment model.
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Arketamine for bipolar depression: Open-label, dose-escalation, pilot study.

Igor D Bandeira1, Gustavo C Leal2, Fernanda S Correia-Melo3

  • 1Laboratório de Neuropsicofarmacologia, Serviço de Psiquiatria do Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil; Programa de Pós-Graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil; Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, United States.

Journal of Psychiatric Research
|June 29, 2023
PubMed
Summary

Arketamine, an (R)-enantiomer of ketamine, shows promise for treating bipolar depression. This pilot study found rapid antidepressant effects and good tolerability in patients, suggesting a potential new therapy option.

Keywords:
AntidepressantArketamineBipolar depressionBipolar disorderGlutamateKetamineMajor depressionNMDA

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Area of Science:

  • Neuroscience
  • Psychiatry
  • Pharmacology

Background:

  • Bipolar depression has limited treatment options compared to major depressive disorder.
  • There is a pressing need for novel and effective therapeutic strategies.

Purpose of the Study:

  • To evaluate the feasibility and safety of arketamine as an adjunct treatment for bipolar depression.
  • To assess the preliminary efficacy of arketamine in reducing depressive symptoms.

Main Methods:

  • A pilot study involving six subjects diagnosed with bipolar disorder types I and II in a depressive episode.
  • Subjects received two intravenous infusions of arketamine (0.5 mg/kg followed by 1 mg/kg one week later).
  • Depressive symptoms were assessed using the Montgomery-Åsberg Depression Rating Scale (MADRS).

Main Results:

  • A significant decrease in MADRS scores was observed 24 hours after the first (0.5 mg/kg) infusion (p=0.036).
  • A further significant reduction in MADRS scores occurred 24 hours after the second (1 mg/kg) infusion (p<0.001).
  • Arketamine was well-tolerated, with minimal dissociation and no emergent manic symptoms.

Conclusions:

  • Arketamine demonstrated rapid-acting antidepressant properties in patients with bipolar depression.
  • This pilot trial suggests arketamine is a feasible and safe treatment option.
  • Further research is warranted to confirm these findings in larger trials.