Ketamine, TMS and ECT for Bipolar Depression
Chris Aiken
December 31, 2025 DOI: 10.64239/pi-vl10011 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Review |
|---|---|
| Intervention | Ketamine |
| Duration | One-month treatment |
| Topics | Depression Esketamine Ketamine |
| Key findings | Ketamine should be used cautiously in bipolar disorder due to psychosis risk, while ECT offers faster remission for severe cases, and TMS response improves with a positive mental state before treatment. |
Abstract
Ketamines should be used cautiously in bipolar disorder due to its potential to trigger psychosis, and is best reserved for short-term (one-month) treatment of severe depression that might otherwise require hospitalization. While both ECT and TMS are effective for bipolar depression, ECT acts faster and is preferred for more severe cases with psychotic features, with studies showing remission rates as high as 95%. For bipolar depression, TMS is more effective when patients arrive in a positive mental state; encourage enjoyable activities in the hour before treatment to get a better response.
Comparable studies
Other narrative reviews on ketamine for depression, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Synthesizing the Evidence for Ketamine and Esketamine in Treatment-Resistant Depression: An International Expert Opinion on the Available Evidence and Implementation Adults with treatment-resistant depression | 2021 | Review | |
| Ketamine: a paradigm shift for depression research and treatment | 2019 | Review | |
| Rapid‐acting antidepressant ketamine, its metabolites and other candidates: A historical overview and future perspective | 2019 | Review | |
| Ketamine: A tale of two enantiomers | 2020 | Review | |
| Molecular mechanisms underlying the antidepressant actions of arketamine: beyond the NMDA receptor | 2021 | Review |