Ketamine Treatment for Bipolar Depression

Christopher Fischer, MD, board-certified psychiatrist

The use of ketamine treatments for bipolar depression is an area of ongoing research and clinical need. Ketamine has shown promise as a rapid-acting antidepressant in studies, and this has led researchers to explore its potential for various mood disorders, including bipolar depression.

Bipolar disorder is characterized by episodes of depression and mania (or hypomania). Standard treatments for bipolar depression often include mood stabilizers, atypical antipsychotics, and other medications. However, some individuals may not respond adequately to these conventional treatments for the depression phase of the illness.

The main concern of ketamine treatment for bipolar depression is the risk of inducing a manic episode. Although there is a potential increased risk for symptoms of mania, research suggests that these symptoms typically tend to resolve within 1 to 2 hours of the infusion. Ensuring that a patient with bipolar disorder is on a mood stabilizer or a neuroleptic prior to starting treatment would decrease risk of inducing mania. A metanalysis showed that treatment emergent mania did not occur more frequently in the active treatment group compared to a group receiving a placebo. Patients with bipolar disorder seeking treatment with ketamine should be carefully evaluated and monitored by a psychiatrist prior to initiation of treatment.

Reference/further reading:

Walsh, Z., Mollaahmetoglu, O., Rootman, J., Golsof, S., Keeler, J., Marsh, B., . . . Morgan, C. (2022). Ketamine for the treatment of mental health and substance use disorders: Comprehensive systematic review. BJPsych Open, 8(1), E19. doi:10.1192/bjo.2021.1061