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Adjunctive music improves the tolerability of intravenous ketamine for bipolar depression

Kyle T. Greenway, Nicolas Garel, Nathalie Goyette, Gustavo Turecki, S. Richard-Devantoy

International Clinical Psychopharmacology April 23, 2021 DOI: 10.1097/yic.0000000000000363 (opens in new tab)

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Study at a glance

AI-extracted from the abstract
Characteristics Case study Case report Peer reviewed
Sample size 2
Population Patients with bipolar 1 disorder and severe depression
Interventions Intravenous ketamine Adjunctive music
Duration Six ketamine infusions
Topics Depression Esketamine Ketamine
Citations 12
Key findings Adjunctive music diminished distress from ketamine-induced dissociation in two patients with bipolar 1 depression, and both achieved remission after six infusions.

Abstract

Intravenous ketamine is an effective treatment of bipolar depression. One of its most important side-effects is a transient altered state of consciousness commonly referred to as dissociation. These states can be anxiety-provoking, distressing and even treatment-limiting, warranting research into mitigation strategies. In this article, we present two cases that demonstrate the potential of adjunctive music to diminish the distress associated with ketamine-induced dissociation – though not necessarily its degree – in bipolar 1 disorder. Both patients suffering from severe depression underwent their first ketamine infusion without music and opted for music with subsequent infusions. They reported that music significantly improved the tolerance of their dissociative symptoms, thereby reducing distress and facilitating subsequent treatments. Both patients achieved remission from their highly treatment-resistant depressive episodes following six ketamine infusions. This is the first report of music’s benefits on ketamine for bipolar 1 depression, though there is precedence in the scientific literature on ‘psychedelics’ where the use of music in combination with medication-induced altered states has been studied. The principles regarding music selection that have resulted from this paradigm may be applicable to the use of ketamine in unipolar and bipolar depression. The optimal use of music with ketamine warrants further research.

Comparable studies

Other case reports and case series on ketamine for depression, most cited first.

Study Year Design Participants
Electroconvulsive Therapy, Ketamine, and Esketamine in a Patient with Major Depressive Disorder and Multiple Comorbidities: A Case Report over 10-year Treatment from Adolescence to Adulthood. A patient with treatment-resistant depression and comorbid generalized anxiety... 2025 Case report n = 1
Oral Administration of the NMDA Receptor Antagonist S-Ketamine as Add-On Therapy of Depression: A Case Series Four depressed patients taking standard antidepressants 2009 Case series n = 4
A longitudinal case series of IM ketamine for patients with severe and enduring eating disorders and comorbid treatment‐resistant depression Patients with enduring eating disorders and treatment-resistant depression 2021 Case series n = 4
Effects of intranasal (S)-ketamine on Veterans with co-morbid treatment-resistant depression and PTSD: A retrospective case series Veterans with co-morbid depression and PTSD 2022 Retrospective case series n = 35
Case report: Intramuscular ketamine or intranasal esketamine as a treatment in four patients with major depressive disorder and comorbid anorexia nervosa Patients with anorexia nervosa and a comorbid depressive disorder treated at a private... 2023 Case report n = 4

Citations in the library

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Related reading

Explore topics

Depression Esketamine Ketamine Altered states of consciousness Anxiety Philosophy of mind

By condition and practice

Ketamine for depression