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Ketamine dosing formula in treatment-resistant bipolar depression
Aleksander Kwaśny1, Wiesław Jerzy Cubała2, Alina Wilkowska2
1Department of Psychiatry, Faculty of Medicine, Medical University of Gdansk, ul. Smoluchowskiego 17, Gdańsk 80-214, Poland.
Therapeutic Advances in Psychopharmacology
|November 20, 2025
Summary
Actual body weight (ABW) dosing for intravenous ketamine in treatment-resistant bipolar depression (TRBD) appears more reliable than alternative formulas. Further research is needed to confirm optimal dosing strategies.
Area of Science:
- Psychiatry
- Pharmacology
- Clinical Research
Background:
- Intravenous ketamine is a recognized treatment for treatment-resistant bipolar depression (TRBD).
- Current dosing protocols for ketamine in TRBD predominantly rely on actual body weight (ABW).
Purpose of the Study:
- To investigate if alternative dosing normalization formulas impact ketamine treatment response in TRBD patients.
- To compare dosing based on actual body weight (ABW) versus lean body mass (LBM), ideal body weight (IBW), and body surface area (BSA).
Main Methods:
- Retrospective analysis of a naturalistic registry for short-term ketamine administration.
- Dose recalculations using Boer and Devine (LBM/IBW) and Mosteller (BSA) formulas for 22 TRBD inpatients.
- Comparison of recalculated doses against ABW dosing in responders and non-responders.
Main Results:
- BSA-normalized ketamine doses varied between responders and non-responders.
- LBM- and IBW-based recalculations suggested potential underdosing, especially in non-responders.
- Preliminary data did not support alternative dosing formulas over ABW.
Conclusions:
- Current findings do not favor alternative ketamine dosing formulas (LBM, IBW, BSA) over ABW for TRBD.
- Larger, controlled studies are necessary to validate these preliminary observations and establish optimal dosing.
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