Ketamine for Bipolar Depression: Biochemical, Psychotherapeutic, and Psychedelic Approaches
Raquel Bennett, Christian Yavorsky, Gary Bravo
Frontiers in Psychiatry May 23, 2022 DOI: 10.3389/fpsyt.2022.867484 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Theoretical or philosophical paper Peer reviewed |
|---|---|
| Intervention | Ketamine |
| Topics | Anxiety Ketamine Depression Esketamine |
| Keywords | Bipolar disorder Depression economics Antidepressant Psychotherapist Refractory planetary science Clinical psychology Cognition |
| Citations | 12 |
| Key points | Proposes three paradigms for ketamine treatment—biochemical, psychotherapeutic, and psychedelic—with broad applicability beyond bipolar depression. |
Abstract
Bipolar disorder (type 1) is a serious and chronic psychiatric illness that can be difficult to treat. Many bipolar patients have refractory depressive episodes. Racemic ketamine, a glutamate modulator with prominent dissociate and psychedelic properties, has been demonstrated to have rapid acting antidepressant and anti-obsessional effects which may be useful for treating the symptoms of bipolar depression. Most of the existing research literature on unipolar and bipolar depression has looked at racemic ketamine in the sub-psychedelic dose range given by infusion as a stand-alone treatment (without concurrent psychotherapy). This article expands on the existing research by articulating three different paradigms for ketamine treatment: biochemical, psychotherapeutic, and psychedelic. The authors use composite clinical vignettes to illustrate different ways of working with ketamine to treat bipolar depression, and discuss a variety of clinical considerations for using ketamine with this population, including route, dose, frequency, chemical mitigators, and adverse events. Note that the conceptual paradigms could be applied to any ketamine treatment, with broad applicability beyond bipolar treatment.