Intravenous Ketamine Infusions in Treatment-Resistant Bipolar Depression: An Open-Label Naturalistic Observational Study

Alina Wilkowska, Adam W&lstrok;odarczyk, Maria Ga&lstrok;uszko-W&eogon;gielnik, Mariusz S Wiglusz, Wies&lstrok;aw J Cuba&lstrok;a Department of Psychiatry, Faculty of Medicine, Medical University of Gda&nacute;sk, Gda&nacute;sk, PolandCorrespondence: Alina WilkowskaDepart...

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Autores principales:	Wilkowska A, Włodarczyk A, Gałuszko-Węgielnik M, Wiglusz MS, Cubała WJ
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2021
Materias:	bipolar depression intravenous ketamine safety tolerability treatment resistant bipolar disorder Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/5e94bf42b6ac447aa18b576d846631ed
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spelling	oai:doaj.org-article:5e94bf42b6ac447aa18b576d846631ed2021-12-02T18:50:45ZIntravenous Ketamine Infusions in Treatment-Resistant Bipolar Depression: An Open-Label Naturalistic Observational Study1178-2021https://doaj.org/article/5e94bf42b6ac447aa18b576d846631ed2021-08-01T00:00:00Zhttps://www.dovepress.com/intravenous-ketamine-infusions-in-treatment-resistant-bipolar-depressi-peer-reviewed-fulltext-article-NDThttps://doaj.org/toc/1178-2021Alina Wilkowska, Adam W&lstrok;odarczyk, Maria Ga&lstrok;uszko-W&eogon;gielnik, Mariusz S Wiglusz, Wies&lstrok;aw J Cuba&lstrok;a Department of Psychiatry, Faculty of Medicine, Medical University of Gda&nacute;sk, Gda&nacute;sk, PolandCorrespondence: Alina WilkowskaDepartment of Psychiatry, Faculty of Medicine, Medical University of Gda&nacute;sk, Gda&nacute;sk, PolandTel + 48 58 349 26 50Fax + 48 349 27 48Email ali.wilkowska@gmail.comPurpose: Bipolar disorder is a chronic and recurrent condition often associated with treatment resistance and suicidality. There is an unmet need for effective treatment in this group of patients. Ketamine has been demonstrated to have antidepressant and antisuicidal properties in unipolar depression. Most of the available studies concern unipolar depression. Here, we present the efficacy and safety of IV ketamine as an add-on treatment in patients with bipolar I and bipolar II depression.Patients and Methods: Thirteen patients with treatment-resistant bipolar depression (TRBD) received eight IV infusions of 0.5 mg/kg ketamine twice a week over four weeks. This is an open-label naturalistic observational study. Ketamine is an add-on treatment. Depressive symptoms were measured with the Montgomery–Asberg Depression Rating Scale (MADRS), and manic symptoms were measured with the Young Mania Rating Scale (YMRS). Psychomimetic symptoms were assessed with the Clinician-Administered Dissociative States Scale (CADSS) and the Brief Psychiatric Rating Scale (BPRS).Results: The rates of response and remission after the seventh infusion of ketamine were 61.5% and 46.2%, respectively. A significant antisuicidal effect was observed in responders at the 7th infusion. Suicidality was measured with item 10 on the MADRS scale. The average time to respond was between 21.1 and 23.2 days to remission. There was an increase in the CADSS scores during the treatment compared to baseline and follow-up, but no differences between responders and non-responders were observed. No affective switch was observed according to the YMRS scale scores. Ketamine treatment was associated with a transient increase in arterial blood pressure. No serious adverse events, however, were observed.Conclusion: This report presents the preliminary results of IV ketamine effectiveness and safety in treatment-resistant bipolar depression. The findings suggest that it is a feasible, safe and well-tolerated treatment option in this group of patients. There is a definite need for more studies in this field.Keywords: bipolar depression, intravenous ketamine, safety, tolerability, treatment-resistant bipolar disorderWilkowska AWłodarczyk AGałuszko-Węgielnik MWiglusz MSCubała WJDove Medical Pressarticlebipolar depressionintravenous ketaminesafetytolerabilitytreatment resistant bipolar disorderNeurosciences. Biological psychiatry. NeuropsychiatryRC321-571Neurology. Diseases of the nervous systemRC346-429ENNeuropsychiatric Disease and Treatment, Vol Volume 17, Pp 2637-2646 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	bipolar depression intravenous ketamine safety tolerability treatment resistant bipolar disorder Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
spellingShingle	bipolar depression intravenous ketamine safety tolerability treatment resistant bipolar disorder Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429 Wilkowska A Włodarczyk A Gałuszko-Węgielnik M Wiglusz MS Cubała WJ Intravenous Ketamine Infusions in Treatment-Resistant Bipolar Depression: An Open-Label Naturalistic Observational Study
description	Alina Wilkowska, Adam W&lstrok;odarczyk, Maria Ga&lstrok;uszko-W&eogon;gielnik, Mariusz S Wiglusz, Wies&lstrok;aw J Cuba&lstrok;a Department of Psychiatry, Faculty of Medicine, Medical University of Gda&nacute;sk, Gda&nacute;sk, PolandCorrespondence: Alina WilkowskaDepartment of Psychiatry, Faculty of Medicine, Medical University of Gda&nacute;sk, Gda&nacute;sk, PolandTel + 48 58 349 26 50Fax + 48 349 27 48Email ali.wilkowska@gmail.comPurpose: Bipolar disorder is a chronic and recurrent condition often associated with treatment resistance and suicidality. There is an unmet need for effective treatment in this group of patients. Ketamine has been demonstrated to have antidepressant and antisuicidal properties in unipolar depression. Most of the available studies concern unipolar depression. Here, we present the efficacy and safety of IV ketamine as an add-on treatment in patients with bipolar I and bipolar II depression.Patients and Methods: Thirteen patients with treatment-resistant bipolar depression (TRBD) received eight IV infusions of 0.5 mg/kg ketamine twice a week over four weeks. This is an open-label naturalistic observational study. Ketamine is an add-on treatment. Depressive symptoms were measured with the Montgomery–Asberg Depression Rating Scale (MADRS), and manic symptoms were measured with the Young Mania Rating Scale (YMRS). Psychomimetic symptoms were assessed with the Clinician-Administered Dissociative States Scale (CADSS) and the Brief Psychiatric Rating Scale (BPRS).Results: The rates of response and remission after the seventh infusion of ketamine were 61.5% and 46.2%, respectively. A significant antisuicidal effect was observed in responders at the 7th infusion. Suicidality was measured with item 10 on the MADRS scale. The average time to respond was between 21.1 and 23.2 days to remission. There was an increase in the CADSS scores during the treatment compared to baseline and follow-up, but no differences between responders and non-responders were observed. No affective switch was observed according to the YMRS scale scores. Ketamine treatment was associated with a transient increase in arterial blood pressure. No serious adverse events, however, were observed.Conclusion: This report presents the preliminary results of IV ketamine effectiveness and safety in treatment-resistant bipolar depression. The findings suggest that it is a feasible, safe and well-tolerated treatment option in this group of patients. There is a definite need for more studies in this field.Keywords: bipolar depression, intravenous ketamine, safety, tolerability, treatment-resistant bipolar disorder
format	article
author	Wilkowska A Włodarczyk A Gałuszko-Węgielnik M Wiglusz MS Cubała WJ
author_facet	Wilkowska A Włodarczyk A Gałuszko-Węgielnik M Wiglusz MS Cubała WJ
author_sort	Wilkowska A
title	Intravenous Ketamine Infusions in Treatment-Resistant Bipolar Depression: An Open-Label Naturalistic Observational Study
title_short	Intravenous Ketamine Infusions in Treatment-Resistant Bipolar Depression: An Open-Label Naturalistic Observational Study
title_full	Intravenous Ketamine Infusions in Treatment-Resistant Bipolar Depression: An Open-Label Naturalistic Observational Study
title_fullStr	Intravenous Ketamine Infusions in Treatment-Resistant Bipolar Depression: An Open-Label Naturalistic Observational Study
title_full_unstemmed	Intravenous Ketamine Infusions in Treatment-Resistant Bipolar Depression: An Open-Label Naturalistic Observational Study
title_sort	intravenous ketamine infusions in treatment-resistant bipolar depression: an open-label naturalistic observational study
publisher	Dove Medical Press
publishDate	2021
url	https://doaj.org/article/5e94bf42b6ac447aa18b576d846631ed
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Intravenous Ketamine Infusions in Treatment-Resistant Bipolar Depression: An Open-Label Naturalistic Observational Study

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