• Isha Team

Ketamine For Bipolar Disorder

Bipolar disorder also known as manic depression or manic manic depressive illness is a mental health condition that causes extreme changes in mood, energy, concentration, activity level and performance. The mood changes range between extremely high energy levels (manic episodes) or irritability and extremely low energy levels or hopeless behaviour (depressive episodes). Less severe manic episodes are also known as hypomanic episodes. Bipolar disorders are categorised into Bipolar 1 disorder, Bipolar 2 disorder, and Cyclothymic Disorder or Cyclothymia.

According to advanced research and statistical analysis, bipolar disorder is prevalent among 2.8% of the adult US population. 2.9% of the male population and 2.8% of females are affected by bipolar disorder. Moreover, among all psychiatric disorders, bipolar disorder has the highest lifetime risk of suicidal thoughts.

bipolar depression

How Does Ketamine Work in Bipolar Depression?

Ketamine exerts an antidepressant effect by blocking NMDA receptors at inhibitory interneurons. In addition to NMDAR, Ketamine affects AMPA receptors and a few other pathways like BDNF-tyrosine kinase receptor B (TrkB) and the mechanistic target of rapamycin (mTOR). Activation of BDNF-tyrosine kinase receptor B for a long time has a long-lasting antidepressant effect.

Moreover, Ketamine triggers a long-lasting state of neuroplasticity in frontocorticolimbic pyramidal neurons that enhance its antidepressant effects. These complex interactions between glutamate, regional synaptic hemostasis, and serotonin contribute to the neuroplastic mechanism of action of ketamine. Thus, significantly reducing the stress and depression in bipolar disorder.

Ketamine has shown promising results in the treatment of bipolar depression, treatment-resistant bipolar depression, PTSD, and treatment-resistant depression (TRD).

Following data and research studies indicate the effectiveness of ketamine in patients with bipolar depression.

Effect of Single Dose of Ketamine in Bipolar Depression:

In a randomised add-on trial of the effect of a single dose of ketamine in patients with treatment-resistant depression, 18 subjects with treatment-resistant bipolar depression received an intravenous infusion of Ketamine (0.5mg/kg) and a placebo. Administration of a single dose of ketamine was repeated after 14 days.

As a result, depressive symptoms improved within 40 minutes of administration of ketamine as compared to placebo and its effect remained for 3 days. 71% of the patients responded to ketamine and 6% responded to placebo during this trial. It was concluded that ketamine is well tolerated in most patients and is effective in treating treatment-resistant bipolar depression.

Multiple Doses of ketamine in Bipolar Disorder:

Roger S et Al. analysed the effectiveness of repeated Intravenous ketamine on suicidal ideation, depressive symptoms, and functional disability in patients with major depressive disorders (MDD) and bipolar disorders (BPD). Patients with MDD or BPD who didn't respond to traditional antidepressants received 4 infusions of ketamine (dosage=0.5–0.75 mg/kg) at a multi-disciplinary clinic.

As a result, after 4 infusions, a significant improvement in depressive symptoms was observed. The response rate after multiple doses of ketamine was 27% and the remission rate was approximately 13%. Ketamine exerted anxiolytic effects, reduced suicidal ideation and improvement in overall psychosocial function was observed.

Rapid Antisuicidal Effects of Ketamine in Patients with Bipolar Depression:

Among all mental health disorders, bipolar disorders are the most common cause of suicidal deaths. Ketamine can significantly reduce suicidal ideation.

Zhan Y, et al conducted a preliminary study to observe the Antisuicidal effects of ketamine in patients with bipolar disorders and suicidal ideation. 86 patients with unipolar and bipolar depression received Ketamine infusions 6 times in a period of 12 days. In all patients, Hamilton Depression Rating Scale (HAMD) and Beck Scale for Suicide Ideation (SSI) were checked at baseline, at intervals of 4 hours and 24 hours after administration of ketamine and finally after 14 days of follow-up.

Among 49 patients out of 86 (57%), suicidal ideation was relieved after the first infusion of ketamine. After 6 infusions, Antisuicidal effects of ketamine were observed in 56 patients (65%). Rapid Antisuicidal effects of ketamine and its efficacy were confirmed in this study. The low SI group showed a higher antisuicidal effect as compared to the high SI group.

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Start Your Journey With Isha Health!

Isha health provides online ketamine-assisted therapy in the privacy and comfort of your home. Our dedicated team of licensed clinicians and therapists makes sure you go through ketamine-assisted therapy safely and effectively. Our personalized and guided approach helps you heal and live a healthy life. Start your journey of transformation with us today. Click here to book an appointment.

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