Bipolar 1 disorder involves episodes of severe mania and depression [1]. Manic symptoms include:
- Euphoric, expansive mood
- Decreased need for sleep
- Racing thoughts and rapid speech
- Impulsiveness and risk-taking behaviors
- Irritability and aggression
Depressive episodes involve extreme sadness, low energy, and loss of interest in activities.
Bipolar 2 involves hypomania – milder versions of manic symptoms that do not impair function – and depression [2]. Mood episodes typically last weeks to months.
Ketamine has shown promise to reduce manic and depressive symptoms in bipolar disorder rapidly. One study found a single ketamine infusion had marked anti-manic effects for up to 2 weeks [3]. Other studies show it quickly improves depressive symptoms within hours to days [4].
Ketamine is thought to help stabilize mood and energy levels in bipolar disorder by correcting dysfunction in glutamate signaling and neural plasticity [5].
Repeated ketamine infusions, along with mood-stabilizing medication and psychotherapy, may help sustain remission and prevent relapse of mood episodes long-term [6]. More research is still needed.
Overall, ketamine provides a fast-acting option for managing bipolar depression and mania that could revolutionize treatment. Its ability to rapidly normalize mood could save lives during acute episodes of illness.
References:
[1] American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
[2] National Institute of Mental Health. (2022). Bipolar Disorder. https://www.nimh.nih.gov/health/topics/bipolar-disorder
[3] Sos P, Klirova M, Novak T, Kohutova B, Horacek J, Palenicek T. Relationship of ketamine’s antidepressant and psychotomimetic effects in unipolar depression. Neuro Endocrinol Lett. 2013;34(4):287-293.
[4] Diazgranados N, Ibrahim L, Brutsche NE, et al. A randomized add-on trial of an N-methyl-D-aspartate antagonist in treatment-resistant bipolar depression. Arch Gen Psychiatry. 2010;67(8):793-802. doi:10.1001/archgenpsychiatry.2010.90
[5] Cousins DA, Butts K, Young AH. The role of dopamine in bipolar disorder. Bipolar Disord. 2009;11(8):787-806. doi:10.1111/j.1399-5618.2009.00760.x
[6] Phillips JL, Norris S, Talbot J, et al. Single, Repeated, and Maintenance Ketamine Infusions for Treatment-Resistant Depression: A Randomized Controlled Trial. Am J Psychiatry. 2019;176(5):401-409. doi:10.1176/appi.ajp.2018.18070834