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Optimizing Ketamine Infusion Therapy for Treatment-Resistant Bipolar Depression: Commentary on Zhou et al. (2023)
Chih-Cheng Lin1, Lien-Chung Wei2,3
1Department of General Psychiatry, Taoyuan Psychiatric Center, Ministry of Health and Welfare, Taoyuan City, Taiwan (Republic of China).
Objectives:
To contextualize the real-world findings of repeated intravenous ketamine infusions for treatment-resistant bipolar depression (TRBPD) and identify priorities for safer, more durable clinical implementation.
Methods:
We provide a focused commentary on Zhou et al. (2023) and integrate selected evidence concerning inflammatory and metabolic correlates, neurocognitive outcomes, and continuation-phase ketamine treatment.
Results:
Repeated subanesthetic ketamine infusions may rapidly improve depressive and anxiety symptoms with an acceptable short-term safety profile. However, the predictive value of C-reactive protein and body mass index varies across cohorts; available cognitive findings are reassuring but limited; and relapse after induction highlights the need for individualized maintenance planning.
Conclusions:
Ketamine pathways for TRBPD should combine cautious patient stratification, repeatable cognitive monitoring, and explicit continuation or booster strategies. Prospective bipolar-specific studies are needed to clarify predictors, durability, and stopping rules.
