Ketamine for bipolar depression: a systematic review
This review (2021; s=6; n=135) found that ketamine (35mg/70kg; 1-6 doses) achieved a response (>50% reduction) on a score of depression for 61% of those suffering from bipolar depression (BD), compared to 5% for placebo.
Authors
- Carlos Zarate
Published
Abstract
Background
Ketamine appears to have a therapeutic role in certain mental disorders, most notably unipolar major depressive disorder. However, the efficacy in bipolar depression is less clear.
Objectives
This study aimed to assess the efficacy and tolerability of ketamine for bipolar depression.
Methods
We conducted a systematic review of experimental studies using ketamine for the treatment of bipolar depression. We searched PubMed, MEDLINE, Embase, PsycINFO, and the Cochrane Central Register for relevant studies published since database inception. We synthesized evidence regarding efficacy (improvement in depression rating scores) and tolerability (adverse events, dissociation, dropouts) across studies.
Findings
We identified six studies, with 135 participants (53% female, 44.7 years, SD 11.7 years). All studies used 0.5 mg/kg of add-on intravenous racemic ketamine, with the number of doses ranging from one to six; all participants continued a mood-stabilizing agent. The overall proportion achieving a response (defined as those having a reduction in their baseline depression severity of at least 50%) was 61% for those receiving ketamine and 5% for those receiving a placebo. The overall response rates varied from 52% to 80% across studies. Ketamine was reasonably well-tolerated; however, two participants (one receiving ketamine and one receiving placebo) developed manic symptoms. Some participants developed significant dissociative symptoms at the 40-minute mark following ketamine infusion in two trials.
Conclusions
There is some preliminary evidence for intravenous racemic ketamine to treat adults with bipolar depression. There is a need for additional studies exploring longer-term outcomes and alterative formulations of ketamine.
Research Summary of 'Ketamine for bipolar depression: a systematic review'
Introduction
Bipolar depression is a major contributor to global disability and treatment-resistant bipolar depression (TRBD) is common yet undertreated, with few well-established therapeutic options beyond electroconvulsive therapy and repetitive transcranial magnetic stimulation. Earlier research has shown rapid antidepressant effects of single sub‑anaesthetic intravenous racemic ketamine in unipolar major depression, including short‑term reductions in suicidal ideation, but the evidence base for ketamine in bipolar depression has been smaller and less clear. Attempts to prolong ketamine's acute effects with other glutamatergic agents have produced inconsistent results, and questions remain about optimal dosing, formulation, and long‑term outcomes in bipolar disorder. Bahji and colleagues set out to update prior reviews by systematically synthesising experimental studies that examined the efficacy and tolerability of ketamine for bipolar depression. The authors focused on controlled and nonrandomised experimental studies in adults and aimed to summarise outcomes related to depressive symptom change, response rates, and adverse events, while assessing study quality and gaps that warrant further research.
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Study Details
- Study Typemeta
- Journal
- Compounds
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- APA Citation
Bahji, A., Zarate, C. A., & Vazquez, G. H. (2021). Ketamine for bipolar depression: a systematic review. International Journal of Neuropsychopharmacology, 24(7), 535-541. https://doi.org/10.1093/ijnp/pyab023
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Cited By (1)
Papers in Blossom that reference this study
Shamabadi, A., Ahmadzade, A., Hasanzadeh, A. · British Journal of Clinical Pharmacology (2022)
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