Ketamine for Bipolar Disorder Treatment

Table of ContentsView AllTable of ContentsHow Does Ketamine Work?EffectivenesssBenefitsThings to ConsiderCost

Table of ContentsView All

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Table of Contents

How Does Ketamine Work?

Effectivenesss

Benefits

Things to Consider

Cost

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You may have heard aboutketamine treatment for depression, but did you know ketamine can also be used to treat bipolar disorder? Specifically, it is used to treat the depression “pole” of bipolar.

Ketamine is being lauded as a treatment for depression as it can improve mood quickly—often within hours. Because bipolar disorder has such a high rate of treatment resistance and suicidality, this can be significant, as conventional treatments for mood disorders often take some time to work.

How Does Ketamine for Bipolar Treatment Work?

Ketamine exists in two different formschemically—r-ketamine and s-ketamine. They areenantiomers, meaning they have the same chemical formula but are mirror images of one another.

A mix of R-ketamine and S-ketamine is generally used forIV infusions, and generally show more robust effects than s-ketamine (typically used inSpravatonose spray).

Ketamine is thought to be so effective because it works on so many different systems in the brain. One of the biggest systems it works on is the glutamate system. Glutamate is an excitatory neurotransmitter that helpsneuronscommunicate. In fact, it is present in upwards of 90% of all synapses in the brain.

When someone has been dealing with chronic stress or chronic depression the glutamate system can be dysregulated.

Ketamine is an N-methyl-D-asparate (NMDA) antagonist, which means that it influences the activity of glutamate in the brain. Learning, memory andneuroplasticityprocesses all depend on the activities of the NMDA receptors.

First, ketamine induces changes in brain chemistry, which can improve symptoms in hours (hence the rapid decrease in suicidality). It then stimulates the growth of synapses, which help neurons in the brain connect with each other.

Decreased neuronal synapses are often observed in depression, but ketamine increases the formation of new synapses in the brain, which help builds neural plasticity.

How Effective Is Ketamine for Bipolar Disorder Treatment?

Additionally, upwards of 25% of those with bipolar disorder are treatment-resistant, meaning at least two or more mood agents have failed.

Because of these statistics, finding an effective treatment that works rapidly is key. In one study, more than 75% of patients responded to ketamine within 40 minutes, with decreased mood symptoms and suicidal ideation, while 0% responded to treatment as usual in that time period.

Treating Bipolar Disorder

Benefits of Ketamine for Bipolar Disorder

Some researchers describe three different ways of working with ketamine to treat bipolar depression.

Although ketamine is generally safe and well-tolerated in medical settings, it is still a powerful treatment that can be expensive and have some side effects you will want to know about.

Time

Because ketamine, in most of its formats, will cause some dissociative effects, and/or dizziness/fogginess, you will be recommended not to drive anywhere from six to 24 hours, so you may need to depend on others to drive you. It is generally administered two to three times a week for a few weeks.

Additionally, you will want to factor in time to prepare yourself mentally for treatment, as well as time after for recovery—so, in addition to the financial commitment, it is also a time commitment.

Mania

Although there is limited evidence of ketamine causing a switch from depression to mania, the potential for this danger does exist.

Substance Use

Although ketamine is a substance with addictive potential, when used therapeutically, the risks appear to be relatively low (but not zero). In fact, ketamine treatment has even been found to help some dealing with certain substance use issues.

Physical Side Effects

Ketamine was originally developed as an anesthetic (though it is given at  significantly higher doses for anesthesia than for bipolar treatment), many of the side effects are similar to those you might deal with if you were under anesthesia, though they are all temporary and should subside within a few hours.

Temporary side effects may include nausea, mild sedation and/or dizziness. Also, it may interact with certain other medications.

Summary

Ketamine holds significant promise for treating aspects of bipolar and other mood disorders, but, like any medical treatment, you should consult with your doctor before moving forward with any new treatments for your condition.

I Tried It: At-Home Ketamine Therapy

6 SourcesVerywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Jelen LA, Young AH, Stone JM.Ketamine: A tale of two enantiomers. J Psychopharmacol. 2021;35(2):109-123. doi:10.1177/0269881120959644Baldessarini RJ, Vázquez GH, Tondo L.Bipolar depression: a major unsolved challenge. Int J Bipolar Disord. 2020;8:1. doi:10.1186/s40345-019-0160-1Zarate CA, Brutsche NE, Ibrahim L, et al.Replication of ketamine’s antidepressant efficacy in bipolar depression: a randomized controlled add-on trial. Biol Psychiatry. 2012;71(11):939-946. doi:10.1016/j.biopsych.2011.12.010Bennett R, Yavorsky C, Bravo G.Ketamine for bipolar depression: biochemical, psychotherapeutic, and psychedelic approaches. Front Psychiatry. 2022;0. doi:10.3389/fpsyt.2022.867484Schak KM, Vande Voort JL, Johnson EK, et al.Potential risks of poorly monitored ketamine use in depression treatment. AJP. 2016;173(3):215-218. doi:10.1176/appi.ajp.2015.15081082Walsh Z, Mollaahmetoglu OM, Rootman J, et al.Ketamine for the treatment of mental health and substance use disorders: comprehensive systematic review.BJPsych open. 2022;8(1):e19. doi:10.1192/bjo.2021.1061

6 Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Jelen LA, Young AH, Stone JM.Ketamine: A tale of two enantiomers. J Psychopharmacol. 2021;35(2):109-123. doi:10.1177/0269881120959644Baldessarini RJ, Vázquez GH, Tondo L.Bipolar depression: a major unsolved challenge. Int J Bipolar Disord. 2020;8:1. doi:10.1186/s40345-019-0160-1Zarate CA, Brutsche NE, Ibrahim L, et al.Replication of ketamine’s antidepressant efficacy in bipolar depression: a randomized controlled add-on trial. Biol Psychiatry. 2012;71(11):939-946. doi:10.1016/j.biopsych.2011.12.010Bennett R, Yavorsky C, Bravo G.Ketamine for bipolar depression: biochemical, psychotherapeutic, and psychedelic approaches. Front Psychiatry. 2022;0. doi:10.3389/fpsyt.2022.867484Schak KM, Vande Voort JL, Johnson EK, et al.Potential risks of poorly monitored ketamine use in depression treatment. AJP. 2016;173(3):215-218. doi:10.1176/appi.ajp.2015.15081082Walsh Z, Mollaahmetoglu OM, Rootman J, et al.Ketamine for the treatment of mental health and substance use disorders: comprehensive systematic review.BJPsych open. 2022;8(1):e19. doi:10.1192/bjo.2021.1061

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Jelen LA, Young AH, Stone JM.Ketamine: A tale of two enantiomers. J Psychopharmacol. 2021;35(2):109-123. doi:10.1177/0269881120959644Baldessarini RJ, Vázquez GH, Tondo L.Bipolar depression: a major unsolved challenge. Int J Bipolar Disord. 2020;8:1. doi:10.1186/s40345-019-0160-1Zarate CA, Brutsche NE, Ibrahim L, et al.Replication of ketamine’s antidepressant efficacy in bipolar depression: a randomized controlled add-on trial. Biol Psychiatry. 2012;71(11):939-946. doi:10.1016/j.biopsych.2011.12.010Bennett R, Yavorsky C, Bravo G.Ketamine for bipolar depression: biochemical, psychotherapeutic, and psychedelic approaches. Front Psychiatry. 2022;0. doi:10.3389/fpsyt.2022.867484Schak KM, Vande Voort JL, Johnson EK, et al.Potential risks of poorly monitored ketamine use in depression treatment. AJP. 2016;173(3):215-218. doi:10.1176/appi.ajp.2015.15081082Walsh Z, Mollaahmetoglu OM, Rootman J, et al.Ketamine for the treatment of mental health and substance use disorders: comprehensive systematic review.BJPsych open. 2022;8(1):e19. doi:10.1192/bjo.2021.1061

Jelen LA, Young AH, Stone JM.Ketamine: A tale of two enantiomers. J Psychopharmacol. 2021;35(2):109-123. doi:10.1177/0269881120959644

Baldessarini RJ, Vázquez GH, Tondo L.Bipolar depression: a major unsolved challenge. Int J Bipolar Disord. 2020;8:1. doi:10.1186/s40345-019-0160-1

Zarate CA, Brutsche NE, Ibrahim L, et al.Replication of ketamine’s antidepressant efficacy in bipolar depression: a randomized controlled add-on trial. Biol Psychiatry. 2012;71(11):939-946. doi:10.1016/j.biopsych.2011.12.010

Bennett R, Yavorsky C, Bravo G.Ketamine for bipolar depression: biochemical, psychotherapeutic, and psychedelic approaches. Front Psychiatry. 2022;0. doi:10.3389/fpsyt.2022.867484

Schak KM, Vande Voort JL, Johnson EK, et al.Potential risks of poorly monitored ketamine use in depression treatment. AJP. 2016;173(3):215-218. doi:10.1176/appi.ajp.2015.15081082

Walsh Z, Mollaahmetoglu OM, Rootman J, et al.Ketamine for the treatment of mental health and substance use disorders: comprehensive systematic review.BJPsych open. 2022;8(1):e19. doi:10.1192/bjo.2021.1061

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