Real-World Effectiveness of Repeated Ketamine Infusions for Treatment-Resistant Bipolar Depression.
Farhan Fancy, Nelson B Rodrigues, Joshua D. Di Vincenzo, Edmond H. Chau, Rickinder Sethi, Muhammad I Husain, Hartej Gill, Aniqa Tabassum, Andrea Mckenzie, Lee Phan, Roger S McIntyre, Joshua D. Rosenblat
FOCUS: The Journal of Lifelong Learning in Psychiatry October 1, 2023 DOI: 10.1176/appi.focus.23021022 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Observational study Peer reviewed |
|---|---|
| Sample size | 66 |
| Population | Patients with treatment-resistant bipolar I/II depression |
| Intervention | IV ketamine |
| Dose | 0.5-0.75 mg/kg |
| Duration | Two-week period |
| Topics | Depression Esketamine Ketamine |
| Keywords | Bipolar disorder Effectiveness Efficacy Function Patient-reported outcomes Quality of life Ketamine therapy Mental health treatments Psychiatric medicine Clinical outcomes |
| Citations | 4 |
| Registration | NCT04209296 |
| Key findings | Repeated IV ketamine infusions produced statistically and clinically significant reductions in depressive symptoms, suicidal thoughts, anxiety, and functional impairment in treatment-resistant bipolar depression. |
Abstract
Clinical trials have demonstrated rapid antidepressant effects with intravenous (IV) ketamine for major depressive disorder, with relatively less research specifically for bipolar depression. Herein, we describe the real-world effectiveness of repeated ketamine infusions for treatment-resistant bipolar depression. This study was conducted in a community clinic in Mississauga, Ontario (Canadian Rapid Treatment Centre of Excellence; Braxia Health). In this observational study (NCT04209296), patients with treatment-resistant bipolar I/II depression (n = 66) received four sub-anesthetic doses of IV ketamine (0.5-0.75 mg/kg) over a two-week period. Symptoms of depression, suicidality, anxiety, and functioning were assessed with validated self-report measures. Statistically and clinically significant antidepressant effects were observed in the overall sample, as measured by the Quick Inventory for Depression Symptomatology-Self Report-16 (QIDS-SR16) with further reductions in depressive symptoms observed after each subsequent infusion (n = 66; mean QIDS-SR16 reduction of 6.08+/-1.39; p < 0.0001). Significant reductions of suicidal thoughts (QIDS-SR16-Suicide Item) and anxiety (Generalized Anxiety Disorder-7) were also observed with functional improvements on the Sheehan Disability Scale (p < 0.0001 on all measures). Moreover, the response rate (QIDS-SR16 total score decrease ≥50% from baseline) was 35% and remission rate (QIDS-SR16 total score ≤5) was 20% after four infusions. Infusions were generally well tolerated with treatment-emergent hypomania observed in only three patients (4.5%) with zero cases of mania or psychosis. Real-world effectiveness of IV ketamine for bipolar depression was observed. Repeated doses were associated with greater symptom reduction and adequate tolerability.Reprinted from Bipolar Disord 2023; 25:99-109, with permission from John Wiley and Sons. Copyright © 2023.
Comparable studies
Other observational and cohort studies on esketamine for depression, most cited first.
Citations in the library
Cited by 4
- Nonresponse to Ketamine in Treatment‐Resistant Bipolar Depression Neuropsychopharmacology Reports July 20, 2025
- Non-inferiority, comparative effectiveness study of intravenous ketamine v. intranasal esketamine for treatment-resistant depression: The EQUIVALENCE trial protocol. Contemporary Clinical Trials March 2, 2026
- Attitudes and Perceptions of Portuguese Psychiatrists and Psychologists on the Clinical Use of Ketamine. Acta Médica Portuguesa May 2, 2025
- Real-World Therapeutic Use of Ketamine in Clinical and Non-Clinical Settings: A Cross-Sectional Survey Journal of Psychoactive Drugs September 23, 2026
Cites 28
- A Randomized Trial of an N-methyl-D-aspartate Antagonist in Treatment-Resistant Major Depression Archives of General Psychiatry August 1, 2006
- Mechanisms of Ketamine Action as an Antidepressant Molecular Psychiatry March 13, 2018
- A Randomized Add-on Trial of an N-methyl-D-aspartate Antagonist in Treatment-Resistant Bipolar Depression Archives of General Psychiatry August 1, 2010
- Efficacy of Esketamine Nasal Spray Plus Oral Antidepressant Treatment for Relapse Prevention in Patients With Treatment-Resistant Depression JAMA Psychiatry June 5, 2019
- 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
and 23 more in the library