Optimizing Ketamine Infusion Therapy for Treatment‐Resistant Bipolar Depression: Commentary on Zhou et al. (2023)
Chih‐Cheng Lin, Lien‐chung Wei
Bipolar Disorders August 30, 2026 DOI: 10.1111/bdi.70177 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Commentary Peer reviewed |
|---|---|
| Intervention | Ketamine |
| Topics | Depression Esketamine Ketamine |
| Key points | Argues that repeated subanesthetic ketamine infusions may rapidly improve depressive and anxiety symptoms in TRBPD with acceptable short-term safety, but relapse after induction and variable predictors underscore the need for individualized maintenance planning, cognitive monitoring, and prospective bipolar-specific studies. |
Abstract
Objectives: To contextualize the real-world findings of repeated intravenous ketamine infusions for treatment-resistant bipolar depression (TRBPD) and identify priorities for safer, more durable clinical implementation.
Methods: We provide a focused commentary on Zhou et al. (2023) and integrate selected evidence concerning inflammatory and metabolic correlates, neurocognitive outcomes, and continuation-phase ketamine treatment.
Results: Repeated subanesthetic ketamine infusions may rapidly improve depressive and anxiety symptoms with an acceptable short-term safety profile. However, the predictive value of C-reactive protein and body mass index varies across cohorts; available cognitive findings are reassuring but limited; and relapse after induction highlights the need for individualized maintenance planning.
Conclusions: Ketamine pathways for TRBPD should combine cautious patient stratification, repeatable cognitive monitoring, and explicit continuation or booster strategies. Prospective bipolar-specific studies are needed to clarify predictors, durability, and stopping rules.