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Ketamine for bipolar depression: an updated systematic review
Farhan Fancy1,2, Sipan Haikazian1,2, Danica E Johnson1,2
1Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada.
Therapeutic Advances in Psychopharmacology
|September 29, 2023
Summary
Intravenous ketamine shows promise for bipolar depression (BD) treatment, with nearly half of patients responding. While generally safe, some experienced manic symptoms, indicating a need for further research.
Area of Science:
- Psychiatry
- Pharmacology
- Neuroscience
Background:
- Subanesthetic ketamine demonstrates therapeutic potential in unipolar depression.
- The efficacy of ketamine for bipolar depression (BD) remains largely uncharacterized.
Purpose of the Study:
- To systematically review the efficacy, safety, and tolerability of ketamine in treating adults with bipolar depression (BD).
Main Methods:
- A systematic review of randomized-controlled trials, open-label trials, and retrospective chart analyses.
- Searched PubMed and Embase databases for studies published up to March 13, 2023.
- Included 8 studies with a total of 235 adult participants with BD.
Main Results:
- Intravenous (IV) ketamine (0.5-0.75 mg/kg) or esketamine (28-84 mg) was used as adjunctive therapy.
- 48% of ketamine recipients achieved a 50% reduction in depression severity versus 5% for placebo.
- Real-world studies showed lower response rates (30%) compared to clinical trials (63%).
- Ketamine was generally well-tolerated, with 2% experiencing hypomanic/manic symptoms and some reporting dissociative effects.
Conclusions:
- Preliminary evidence suggests IV ketamine is safe and effective for treating bipolar depression (BD).
- Further research, particularly randomized controlled trials investigating repeated and maintenance infusions, is warranted.
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