Bipolar disorder is often treated with one of three types of medication: mood stabilizers, anti-psychotics, and anti-depressants. But for patients searching for an alternative to traditional medications (or a means of supplementing them) ketamine therapy is an increasingly accessible option. Though still considered a novel approach, clinical studies have indicated the efficacy of treating bipolar (and comorbid depressive symptoms) with ketamine infusions.
Since the 1970s, ketamine has been used in clinical settings as an anesthetic. But over the past two decades ketamine has been increasingly administered for its mental health benefits—most specifically for its impact on treatment resistant depression. And in 2019, the FDA approved a derivative of ketamine (esketamine) nasal spray for depression.
But ketamine’s mental health benefits extend beyond major depression and evidence suggests that ketamine infusions may be an efficacious way to treat bipolar disorder.
What is Bipolar Disorder?
Bipolar disorder is classified as a mood disorder, and is sometimes referred to as manic depression. People with bipolar disorder may experience manic episodes characterized by rapid and extreme changes in mood, swinging from excited and energized to lethargic and depressed.
Researchers are still studying the exact mechanisms and causes of bipolar disorder, and clinical reviews suggest that genetics may play a significant role in its inception, with some studies indicating a heritability rate of 44%, while others suggest up to 60 and, even, 90% heritability.
It’s also important to note that there are two distinct types of bipolar disorder: people with Bipolar 1 experience both manic and depressive episodes, whereas people with Bipolar 2 (also known as Bipolar depression) may not experience mania—just depression.
In addition to medication, cognitive-behavioral therapy for bipolar disorder is often recommended to supplement treatment.
While there is no single ‘cure’ for bipolar disorder, interventions like Ketamine therapy has shown to be adept at stabilizing mood, reducing suicidal ideation and supporting cognition.
Below, we delve into the promising benefits of ketamine therapy as a safe and well tolerated treatment for people living with bipolar disorder.
Rapid Relief from Depressive Episodes
Bipolar disorder often involves debilitating depressive episodes that can last for weeks or even months, plunging individuals into a state of despair and lethargy. Ketamine, however, can treat bipolar depression. Its rapid antidepressant effects can provide much-needed respite during the darkest phases of bipolar depression.
Mitigation of Suicidal Ideation
Suicidal ideation can be a symptom of bipolar depression, posing a grave threat to the well-being of those affected. In studies focused on patients with suicidal ideation, ketamine has demonstrated antisuicidal effects by stimulating the glutamate system in the brain to help neurons communicate. Some studies even indicate rapid action, with patients reporting relief from suicidal ideation within 72 hours of treatment.
Stabilization of Mood Swings
The hallmark of bipolar disorder is the erratic oscillation between manic highs and depressive lows, wreaking havoc on one’s life and relationships. Ketamine therapy exhibits mood-stabilizing properties, helping to temper the extremes of mood swings and fostering a more balanced emotional state. By mitigating the severity and frequency of mood episodes, ketamine can empower individuals to regain control over their lives.
Enhancement of Cognitive Functioning
Bipolar disorder often exacts a toll on cognitive functioning, impairing memory, concentration, and decision-making abilities. Ketamine stimulates neuroplasticity, which helps the brain form new connections and rewire new thought patterns. And studies indicate that patients with mood disorders who have been treated with ketamine show improvements in mental clarity and problem-solving.
Augmentation of Traditional Treatments
While traditional medications such as mood stabilizers and antipsychotics form the cornerstone of bipolar treatment, they don’t always yield lasting effects on symptoms. Some patients choose ketamine therapy as a means to complement their existing treatments, offering a synergistic effect that amplifies therapeutic outcomes. By targeting different neurotransmitter systems, ketamine fills the therapeutic gap and provides relief where other treatments fall short.
Longer-lasting Effects
Unlike traditional antidepressants, whose benefits may wane over time, ketamine therapy can yield longer-lasting effects. Studies suggest that ketamine induces neuroplasticity, rewiring neural circuits implicated in mood regulation and resilience. This neurobiological remodeling translates into sustained improvements in mood and functioning, offering hope for long-term symptom management.
Reduced Medication Burden
Treatment for bipolar disorder usually includes taking multiple medications, each with its own set of side effects. These medications can be challenging to adhere to. Ketamine therapy offers a welcome departure from the burden of polypharmacy, providing a single intervention that addresses multiple facets of the illness. By streamlining treatment regimens, ketamine minimizes the risk of adverse drug interactions and simplifies the treatment landscape for individuals with bipolar disorder.
Personalized Treatment Protocol
Bipolar disorder is a heterogeneous condition, with diverse symptom presentations and treatment responses across individuals. Ketamine therapy can be customized to fit each patient’s specific needs and preferences. From dosing protocols to infusion frequency, treatment parameters can be customized to optimize therapeutic outcomes and enhance patient satisfaction.
The use of ketamine in treating bipolar disorder marks a significant change in how the condition is managed. This treatment approach tackles the various aspects of the disorder, such as mood swings, cognitive issues, and resistance to traditional treatments.
But more research is still needed to understand how well ketamine works in the long run. So far, the evidence shows that ketamine has the potential to help with bipolar disorder.
Citations
Grunebaum MF, Galfalvy HC, Choo TH, Keilp JG, Moitra VK, Parris MS, Marver JE, Burke AK, Milak MS, Sublette ME, Oquendo MA, Mann JJ. Ketamine for Rapid Reduction of Suicidal Thoughts in Major Depression: A Midazolam-Controlled Randomized Clinical Trial. Am J Psychiatry. 2018 Apr 1;175(4):327-335. doi: 10.1176/appi.ajp.2017.17060647. Epub 2017 Dec 5. PMID: 29202655; PMCID: PMC5880701.
O’Connell KS, Coombes BJ. Genetic contributions to bipolar disorder: current status and future directions. Psychol Med. 2021 Oct;51(13):2156-2167. doi: 10.1017/S0033291721001252. Epub 2021 Apr 21. PMID: 33879273; PMCID: PMC8477227.
Witt K, Potts J, Hubers A, Grunebaum MF, Murrough JW, Loo C, Cipriani A, Hawton K. Ketamine for suicidal ideation in adults with psychiatric disorders: A systematic review and meta-analysis of treatment trials. Aust N Z J Psychiatry. 2020 Jan;54(1):29-45. doi: 10.1177/0004867419883341. Epub 2019 Nov 15. Erratum in: Aust N Z J Psychiatry. 2020
Examining the Effect of Ketamine on Glutamate/Glutamine Cycling, Yale school of medicine, medicine.yale.edu/psychiatry/emerge/research/ketamine-glutamate-depression/.
“Ketamine Rapidly Improves Cognitive Function Making Those in Suicidal Crisis Less Likely to Harm Themselves.” Columbia University Department of Psychiatry, 3 Nov. 2021, www.columbiapsychiatry.org/news/ketamine-rapidly-improves-cognitive-function-making-those-suicidal-crisis-less-likely-harm-themselves.
