Ketamine dosing formula in treatment-resistant bipolar depression.
Aleksander Kwaśny, Wiesław Jerzy Cubała, Alina Wilkowska
Therapeutic Advances in Psychopharmacology 2025 DOI: 10.1177/20451253251392817 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Retrospective exploratory analysis of a naturalistic registry Peer reviewed |
|---|---|
| Sample size | 22 |
| Population | Inpatients with treatment-resistant bipolar depression |
| Intervention | Intravenous ketamine |
| Dose | 0.5 mg/kg |
| Topics | Ketamine Depression Esketamine |
| Keywords | Body surface area Ideal body weight Lean body mass Treatment-resistant bipolar depression Intravenous ketamine treatment Optimizing ketamine's impact Severe bipolar depression Dosing formulas Actual body weight Recalculating doses Alternative calculations |
| Key points | Alternative dosing formulas for intravenous ketamine, such as those based on lean body mass, ideal body weight, or body surface area, did not show advantages over actual body weight dosing in predicting treatment response. |
Abstract
Intravenous ketamine is effective in treatment-resistant bipolar depression (TRBD) with dosing typically based on actual body weight (ABW). This study examined whether alternative normalization formulas are associated with treatment response. A retrospective exploratory analysis of a naturalistic registry for short-term ketamine use. A total of 22 TRBD inpatients received short-term intravenous ketamine. Doses were recalculated using the Boer and Devine formulas for lean body mass (LBM) and ideal body weight (IBW), and the Mosteller formula for body surface area (BSA). Calculated doses were compared with ABW dosing in responders and nonresponders. Using the Mosteller formula, BSA-normalized doses ranged from 17.63-23.09 mg/m2 in nonresponders and 15.73-23.89 mg/m2 in responders. LBM- and IBW-based recalculations at 0.5 mg/kg yielded lower relative doses, particularly among nonresponders, suggesting potential underdosing. These preliminary findings do not support alternative dosing formulas over ABW, but replication in larger controlled studies is warranted.