Ketamine for Bipolar Depression: Biochemical, Psychotherapeutic, and Psychedelic Approaches
Frontiers in Psychiatry May 23, 2022 Raquel Bennett, Christian Yavorsky, Gary Bravo 12 citations
Bipolar disorder type 1 is a serious chronic psychiatric condition often featuring refractory depressive episodes. Racemic ketamine, a glutamate modulator with dissociative and psychedelic properties, has demonstrated rapid antidepressant and anti-obsessional effects that may help treat bipolar depression. Existing research has mostly examined sub-psychedelic doses given by infusion without psychotherapy. This article expands on that work by describing three paradigms for ketamine treatment: biochemical, psychotherapeutic, and psychedelic. The authors use composite clinical vignettes to illustrate different ways of using ketamine for bipolar depression and discuss clinical considerations including route, dose, frequency, chemical mitigators, and adverse events. The paradigms have broad applicability beyond bipolar treatment.