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.
Comparable studies
Other observational and cohort studies on ketamine for depression, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Concomitant BDNF and sleep slow wave changes indicate ketamine-induced plasticity in major depressive disorder Patients with treatment-resistant major depressive disorder | 2012 | Observational cohort | n = 30 |
| Altered peripheral immune profiles in treatment-resistant depression: response to ketamine and prediction of treatment outcome Healthy controls and actively depressed patients with treatment-resistant depression... | 2017 | Observational cohort | n = 59 |
| Clinical Predictors of Ketamine Response in Treatment-Resistant Major Depression Treatment-resistant inpatients with DSM-IV-TR-diagnosed major depressive disorder or... | 2014 | Post hoc analysis of pooled data from four studies | n = 108 |
| An investigation of amino-acid neurotransmitters as potential predictors of clinical improvement to ketamine in depression Drug-free patients with major depressive disorder | 2011 | Observational cohort | n = 14 |
| Efficacy of ketamine therapy in the treatment of depression Drug-free/naïve men with severe depression, no history of psychotic disorder, head... | 2019 | Observational cohort | n = 25 |
Citations in the library
Cites 18
- Synthesizing the Evidence for Ketamine and Esketamine in Treatment-Resistant Depression: An International Expert Opinion on the Available Evidence and Implementation American Journal of Psychiatry March 17, 2021
- A Consensus Statement on the Use of Ketamine in the Treatment of Mood Disorders JAMA Psychiatry March 1, 2017
- A Double-Blind, Randomized, Placebo-Controlled, Dose-Frequency Study of Intravenous Ketamine in Patients With Treatment-Resistant Depression American Journal of Psychiatry April 8, 2016
- Double-Blind, Placebo-Controlled, Dose-Ranging Trial of Intravenous Ketamine as Adjunctive Therapy in Treatment-Resistant Depression (TRD) Molecular Psychiatry October 3, 2018
- Esketamine Nasal Spray Plus Oral Antidepressant in Patients With Treatment-Resistant Depression The Journal of Clinical Psychiatry April 20, 2020
and 13 more in the library