Bipolar Disorders
November 14, 2014
Dawn F. Ionescu, David A. Luckenbaugh, Mark J. Niciu et al.
109 citations
A single infusion of ketamine (0.5 mg/kg) reduced depression symptoms in both anxious and non-anxious patients with treatment-resistant bipolar depression. Thirty-six patients (21 anxious, 15 non-anxious) received the infusion over 40 minutes. Both groups showed significant antidepressant responses on the Montgomery-Åsberg Depression Rating Scale and Hamilton Depression Rating Scale through 14 days post-infusion. The anxious group did not show a disadvantage in antidepressant response compared to the non-anxious group, contrasting with typical poor treatment outcomes for anxious bipolar depression with traditional medications. The findings suggest ketamine may be effective for anxious bipolar depression, warranting further study.
Bipolar Disorders
September 18, 2013
Allison C. Nugent, Nancy Diazgranados, Paul J. Carlson et al.
86 citations
In people with bipolar disorder who are depressed, a single ketamine infusion alters brain glucose metabolism in regions linked to mood disorders. Those who improved most showed the largest metabolic increase in the right ventral striatum. Ketamine also lowered metabolism in the left hippocampus compared with placebo. Higher baseline activity in the subgenual anterior cingulate cortex predicted a stronger antidepressant response to ketamine. These metabolic changes may help explain how ketamine works.
Bipolar Disorders
January 13, 2023
Giovanni Martinotti, Bernardo Dell’osso, Giorgio Di Lorenzo et al.
72 citations
Esketamine nasal spray reduced depressive symptoms in people with treatment-resistant bipolar depression as effectively as in those with unipolar treatment-resistant depression, with no significant differences in response or remission rates after one and three months. The treatment also showed greater anxiety-reducing effects in the bipolar group. No treatment-emergent affective switch occurred, supporting the safety and tolerability of esketamine for bipolar treatment-resistant depression.
Bipolar Disorders
September 14, 2012
David A. Luckenbaugh, Lobna Ibrahim, Nancy E. Brutsché et al.
69 citations
In people with bipolar depression, those who have a first-degree relative with alcohol dependence show a greater and more sustained antidepressant response to a single low dose of ketamine than those without such a family history. The study also found that individuals with a positive family history experienced fewer psychosis-like and dissociative side effects after ketamine infusion. These findings suggest that family history of alcohol dependence may help predict who benefits most from ketamine treatment and should be considered when developing new glutamatergic therapies for depression.
Bipolar Disorders
May 14, 2020
Roger S McIntyre, Orly Lipsitz, Nelson B Rodrigues et al.
64 citations
Intravenous ketamine reduces anxiety, irritability, agitation, and suicidal thoughts in adults with treatment-resistant major depressive disorder or bipolar disorder. In a retrospective analysis of 201 patients at a community clinic, those with elevated anxiety, irritability, and agitation showed significantly greater improvements in overall depressive symptoms, suicidal ideation, anxiety, irritability, and agitation compared to those without these features, regardless of the number of treatments. The findings suggest IV ketamine may be a rapid treatment option for mood disorder patients with mixed features.
Bipolar Disorders
December 14, 2022
Farhan Fancy, Nelson B Rodrigues, Joshua D. Di Vincenzo et al.
35 citations
Four intravenous ketamine infusions (0.5–0.75 mg/kg) given over two weeks to 66 patients with treatment-resistant bipolar depression produced significant antidepressant effects, with depressive symptoms decreasing further after each infusion. Suicidal thoughts and anxiety also significantly decreased, and functioning improved. The response rate was 35% and remission rate 20% after four infusions. Treatment-emergent hypomania occurred in only 4.5% of patients, with no cases of mania or psychosis. Repeated doses were well tolerated and associated with greater symptom reduction.
Bipolar Disorders
February 4, 2024
Alina Wilkowska, Mariusz S. Wiglusz, Aleksandra Arciszewska et al.
17 citations
In patients with treatment-resistant bipolar depression, adding ketamine infusions to ongoing treatment reduced anhedonia, a debilitating symptom linked to suicidality and poor treatment response. Improvement was seen on both patient-reported and clinician-rated measures of anhedonia, and anxiety and mood/cognition symptoms also improved, but sleep symptoms did not. No serious adverse events occurred. The findings suggest ketamine may be a useful option for anhedonia in this population, though further research is needed.
Bipolar Disorders
April 2, 2025
Adam Fijtman, Mani Yavi, Abigail Vogeley et al.
2 citations
Ketamine rapidly reduces depressive symptoms in treatment-resistant depression but does not improve working memory, attention, or concentration. In a crossover trial, 21 individuals with treatment-resistant depression (14 with bipolar disorder, 7 with major depressive disorder) received ketamine or placebo infusions. Brain activity measured by magnetoencephalography during a working memory task showed increased gamma power in the parieto-occipital junction and decreased gamma power in the posterior superior temporal sulcus and inferior frontal gyrus after ketamine compared to placebo. These distinct gamma power changes in brain regions linked to attention and working memory suggest that ketamine alters neural activity without improving cognitive performance, highlighting the need for further research into its neurobiological mechanisms.
Bipolar Disorders
May 1, 2023
William S H Kim, Mikaela K Dimick, Danielle Omrin et al.
In a double-blind randomized controlled trial, 25 adults with bipolar I or II disorder and treatment-resistant depression received either nitrous oxide (25% concentration for 20 minutes) plus intravenous saline or medical air plus intravenous midazolam (2 mg total). No significant between-group differences emerged in depression severity change or treatment response 24 hours after treatment. However, the nitrous oxide group showed significantly greater same-day reductions in depression severity. Lower baseline regional cerebral blood flow predicted greater 24-hour improvement with nitrous oxide but not midazolam. Midazolam was associated with regional cerebral blood flow reductions compared to nitrous oxide. These secondary findings suggest differential associations of the two agents with depression severity and brain hemodynamics, warranting larger studies.
Bipolar Disorders
September 1, 2017
L M Smith, L C Johns, Rlc Mitchell
Psychotic symptoms, especially auditory verbal hallucinations and delusions, are common during both manic and depressive phases of bipolar disorder, though more frequent in mania. Delusions with persecutory, grandiose, and referential themes are most common. Auditory hallucinations often co-occur with delusions, and delusion subtype may vary by mood state and hallucination type. Evidence suggests that how people with bipolar disorder interpret their voices may differ from patterns seen in schizophrenia that predict clinical outcomes. There are significant gaps in understanding the first-person experience of hallucinations in bipolar disorder and their relationship to other symptoms. Further research on cognitive interpretations could inform adapted psychological treatments.