Ketamine for Bipolar Disorder Treatment

Why is BPD an important target for new treatments?

Bipolar disorder (BPD) is a chronic, often severe, mental health condition affecting 4.4% of the US population at some point in life.

Sometimes known as manic-depression, bipolar disorder is characterized by cycling states of mania and depression. During these states, sufferers can experience everything from elation to despair. These extreme emotional swings also affect the person’s decision-making abilities by altering cognition, impulse control, and insight. Here is an overview of Bipolar Disorder.

Bipolar illness is often severe, requires lifelong treatment, and is difficult to manage. Most patients do not achieve and sustain a symptom-free state. Cognitive-behavioral therapy is often combined with pharmaceutical interventions to balance mood, restoring functionality, and preventing relapse. Various classes of medications, mood stabilizers, atypical antipsychotics, and monoaminergics are used alone and in combination, as there is no “one size fits all” prescription.

Bipolar patients usually experience more depression than mania. These long periods of depression, sometimes mixed with high energy and aggravation, may explain why bipolar disorder carries the highest suicide rate of all mood disorders. People experiencing chronic, challenging to treat periods of depression need fast-acting antidepressant alternatives.

A new alternative treatment with potential

Ketamine use in the treatment of bipolar depression is less invasive compared to other treatments such as electroconvulsive therapy (ECT) and Deep brain stimulation (DBS). IV ketamine administration does not require an anesthesiologist on-site and is commonly provided through outpatient clinics. It is generally considered safe and tolerable for those suffering from major depressive disorder or bipolar disorder.

Safety Concerns

One concern of treating Bipolar with any medication is the possibility of triggering manic symptoms. While there are some individual cases of this happening, they appear to be rare.

Common adverse effects of Ketamine are mild and transient: drowsiness, dizziness, poor coordination, blurred vision, and feelings of unreality. Patients may also experience psychotomimetic effects during the infusion period, but these effects usually self-resolve. Additional issues may include elevation in cardiovascular metrics such as breathing rate and blood pressure. For this reason, monitoring vital signs is necessary during Ketamine infusions. Patients’ most pronounced side effects are psychotomimetic and dissociative, both of which self-resolve shortly after treatment.

Ketamine carries some risk of interactions with numerous drugs. With psychiatric implementations, monoaminergic antidepressants and MAO-inhibitors appear to be safe. However, Ketamine’s efficacy may be reduced by benzodiazepines, such as diazepam. Preferably, benzodiazepine intake is titrated down prior to Ketamine administration. Lamictal may also blunt Ketamine’s therapeutic effects. Your physician will manage the determinations of the possibility and prevention of interactions. However, at least anecdotally, patients on multiple medications are often able to receive treatment safely.

Another potential issue is Ketamine’s addictive potential. Besides Ketamine’s sanctioned uses, it also enjoys recreational popularity. However, the infrequent, supervised, low-dose nature of therapeutic applications makes abuse difficult. Your physician will consider your risk level based on your background of addiction (if any).

Recreational Ketamine abuse can injure the cardiovascular, cognitive, respiratory, reproductive, genitourinary, and immune systems. Abuse can also lead to urinary bladder dysfunction and impairment of the renal system, causing cystitis.

As the body of Ketamine treatment experience grows, our knowledge of refining dosing, employing safe, effective protocols, and minimizing chances of dependency, will all increase.

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