Ketamine for bipolar depression: an updated systematic review
Background: The therapeutic potential of subanesthetic doses of ketamine appears promising in unipolar depression; however, its effectiveness in treating bipolar depression (BD) remains uncertain. Objective: This systematic review aimed to summarize findings on the use of ketamine for the treatment...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2023-09-01
|
| Series: | Therapeutic Advances in Psychopharmacology |
| Online Access: | https://doi.org/10.1177/20451253231202723 |
| _version_ | 1797672479368413184 |
|---|---|
| author | Farhan Fancy Sipan Haikazian Danica E. Johnson David C. J. Chen-Li Anastasia Levinta Muhammad I. Husain Rodrigo B. Mansur Joshua D. Rosenblat |
| author_facet | Farhan Fancy Sipan Haikazian Danica E. Johnson David C. J. Chen-Li Anastasia Levinta Muhammad I. Husain Rodrigo B. Mansur Joshua D. Rosenblat |
| author_sort | Farhan Fancy |
| collection | DOAJ |
| description | Background: The therapeutic potential of subanesthetic doses of ketamine appears promising in unipolar depression; however, its effectiveness in treating bipolar depression (BD) remains uncertain. Objective: This systematic review aimed to summarize findings on the use of ketamine for the treatment of BD by assessing its efficacy, safety, and tolerability. Design: Systematic review. Methods: We conducted a systematic review of studies that investigated the use of ketamine for adults with BD. We searched PubMed and Embase for relevant randomized-controlled trials, open-label trials, and retrospective chart analyses published from inception to 13 March 2023. Results: Eight studies were identified [pooled n = 235; mean (SD) age: 45.55 (5.54)]. All participants who received intravenous (IV) ketamine were administered a dose of 0.5–0.75 mg/kg as an adjunctive treatment to a mood-stabilizing agent, whereas participants who received esketamine were administered a dosage ranging from 28 to 84 mg. Flexible dosing was used in real-world analyses. A total of 48% of participants receiving ketamine achieved a response (defined as ⩾50% reduction in baseline depression severity), whereas only 5% achieved a response with a placebo. Real-world studies demonstrated lower rates of response (30%) compared to the average across clinical trials (63%). Reductions in suicidal ideation were noted in some studies, although not all findings were statistically significant. Ketamine and esketamine were well tolerated in most participants; however, six participants (2% of the overall sample pool, 5 receiving ketamine) developed hypomanic/manic symptoms after infusions. Significant dissociative symptoms were observed at the 40-min mark in some trials. Conclusion: Preliminary evidence suggests IV ketamine as being safe and effective for the treatment of BD. Future studies should focus on investigating the effects of repeated acute and maintenance infusions using a randomized study design. |
| first_indexed | 2024-03-11T21:30:40Z |
| format | Article |
| id | doaj.art-44b33ffad39e4c3d948797754231f4ab |
| institution | Directory Open Access Journal |
| issn | 2045-1261 |
| language | English |
| last_indexed | 2024-03-11T21:30:40Z |
| publishDate | 2023-09-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Therapeutic Advances in Psychopharmacology |
| spelling | doaj.art-44b33ffad39e4c3d948797754231f4ab2023-09-27T09:03:37ZengSAGE PublishingTherapeutic Advances in Psychopharmacology2045-12612023-09-011310.1177/20451253231202723Ketamine for bipolar depression: an updated systematic reviewFarhan FancySipan HaikazianDanica E. JohnsonDavid C. J. Chen-LiAnastasia LevintaMuhammad I. HusainRodrigo B. MansurJoshua D. RosenblatBackground: The therapeutic potential of subanesthetic doses of ketamine appears promising in unipolar depression; however, its effectiveness in treating bipolar depression (BD) remains uncertain. Objective: This systematic review aimed to summarize findings on the use of ketamine for the treatment of BD by assessing its efficacy, safety, and tolerability. Design: Systematic review. Methods: We conducted a systematic review of studies that investigated the use of ketamine for adults with BD. We searched PubMed and Embase for relevant randomized-controlled trials, open-label trials, and retrospective chart analyses published from inception to 13 March 2023. Results: Eight studies were identified [pooled n = 235; mean (SD) age: 45.55 (5.54)]. All participants who received intravenous (IV) ketamine were administered a dose of 0.5–0.75 mg/kg as an adjunctive treatment to a mood-stabilizing agent, whereas participants who received esketamine were administered a dosage ranging from 28 to 84 mg. Flexible dosing was used in real-world analyses. A total of 48% of participants receiving ketamine achieved a response (defined as ⩾50% reduction in baseline depression severity), whereas only 5% achieved a response with a placebo. Real-world studies demonstrated lower rates of response (30%) compared to the average across clinical trials (63%). Reductions in suicidal ideation were noted in some studies, although not all findings were statistically significant. Ketamine and esketamine were well tolerated in most participants; however, six participants (2% of the overall sample pool, 5 receiving ketamine) developed hypomanic/manic symptoms after infusions. Significant dissociative symptoms were observed at the 40-min mark in some trials. Conclusion: Preliminary evidence suggests IV ketamine as being safe and effective for the treatment of BD. Future studies should focus on investigating the effects of repeated acute and maintenance infusions using a randomized study design.https://doi.org/10.1177/20451253231202723 |
| spellingShingle | Farhan Fancy Sipan Haikazian Danica E. Johnson David C. J. Chen-Li Anastasia Levinta Muhammad I. Husain Rodrigo B. Mansur Joshua D. Rosenblat Ketamine for bipolar depression: an updated systematic review Therapeutic Advances in Psychopharmacology |
| title | Ketamine for bipolar depression: an updated systematic review |
| title_full | Ketamine for bipolar depression: an updated systematic review |
| title_fullStr | Ketamine for bipolar depression: an updated systematic review |
| title_full_unstemmed | Ketamine for bipolar depression: an updated systematic review |
| title_short | Ketamine for bipolar depression: an updated systematic review |
| title_sort | ketamine for bipolar depression an updated systematic review |
| url | https://doi.org/10.1177/20451253231202723 |
| work_keys_str_mv | AT farhanfancy ketamineforbipolardepressionanupdatedsystematicreview AT sipanhaikazian ketamineforbipolardepressionanupdatedsystematicreview AT danicaejohnson ketamineforbipolardepressionanupdatedsystematicreview AT davidcjchenli ketamineforbipolardepressionanupdatedsystematicreview AT anastasialevinta ketamineforbipolardepressionanupdatedsystematicreview AT muhammadihusain ketamineforbipolardepressionanupdatedsystematicreview AT rodrigobmansur ketamineforbipolardepressionanupdatedsystematicreview AT joshuadrosenblat ketamineforbipolardepressionanupdatedsystematicreview |