Can ketamine be a safe option for treatment-resistant bipolar depression?

Figures & data

Table 1. Summary of the single and serial/multiple intravenous ketamine studies for bipolar depression.

Study (First author et al)	Type of Study	Number of infusions	Total Patients, (Females %)	Main findings
Single infusion studies
Diazgranados et al.	RCT, Crossover (ketamine-Saline placebo)	One	18, (66.7%)	Single ketamine infusion resulted in a robust and rapid antidepressant effect at day 1, which remained significant through day 3.
Zarate et al.	RCT, Crossover (ketamine-Saline placebo)	One	15, (53.3%)	Single ketamine infusion resulted in a robust and rapid antidepressant effect and improvement in suicidal ideation, which remained significant through day 3.
Kantrowitz et al.	Open label	One	8, (62.5%)	25% or more improvement in HAM-D in 7 patients after ketamine infusion.
Grunebaum et al.	RCT, parallel group, (ketamine vs midazolam)	One	16, (62.5%)	There was a non-statistically significant reduction in the depression scores and a trend level of significant reduction in suicidal thoughts with ketamine compared to midazolam.
Rybakowski et al.	Open label	One	53, (75.5%)	Rapid antidepressant effect after single intravenous dose of ketamine infusion and a reduction of ≥50% on HAM-D in 24.5% patients at 24hrs and in 51% patients on the 7^th day after infusion.
Multiple /serial infusion studies
Zheng et al	Open-label	Six	19, (31.6%)	Repeated ketamine infusions at subanesthetic doses for patients with TRBD is feasible. Response and remission rates after the 6^th infusion were 73.7% and 63.2%, respectively.
Wilkowska et al	Open-label Naturalistic observational	Eight	13, (76.9%)	Response and remission rates after the 7^th infusion were 61.5% and 46.2%, respectively. IV ketamine was feasible, safe, and well-tolerated,
Zhuo et al	Open-label	Nine	38, (42.1%)	Average depression scores decreased by 49.8% after starting ketamine augmentation, however, these effects were maintained for only one week. Depressive symptoms started to relapse within two weeks post-ketamine initiation, raising concerns regarding ketamine’s longitudinal efficacy in TRBD.

Data availability statement

Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.