As life becomes more stressful than before, an increasing number of people are developing mental health issues. Disease conditions that were rare a few decades back are common nowadays. One such mental health problem that is not uncommon these days is bipolar disorder. Studies suggest that about 2.8% of the US population, or about eight million people, is living with the condition.(1)
Life can be pretty distressing for those living with bipolar disorder. Further, the condition also affects those living with the patients. The unpredictability of the mood is the hallmark of the condition. Hence, those living with the patient find it difficult to adapt.
What makes this condition different from other common mental health issues is its bi-directional nature, thus called bipolar. It means that periods or emotional highs (mania or hypomania) are followed by lows or depression.
There were times when doctors used to think of it as a kind of depression ailment. However, nowadays, doctors regard it as a distinct health issue. Nonetheless, it is somewhat related to depression. Moreover, many drugs that work for depression also help reduce excitement, anxiety, and depression that occurs in the condition.
People living with the condition experience episodes of severe mood swings multiple times a year. They become abnormally upbeat, full of energy, and talkative and start making quick and wrong decisions. After this, they might fall into depression. They often experience major depression episodes causing depressed mood, complete loss of interest in surroundings, and even suicidal thoughts.
In bipolar disorder, it is always good to take measures to prevent its attacks or episodes. This generally means taking medications regularly. However, medications often fail to prevent its episodes. In many patients, nothing seems to work.
Ketamine Provides Treatment Hope
Managing bipolar disorder is very challenging. Mood swings in the condition occur due to severe brain changes. Moreover, what may work for a maniac attack would not work during depression. There are many medications to manage the condition, but none is perfect. Doctors may use lithium to stabilize mood and prevent maniac attacks. When the patient is stabilized, they might use antipsychotics. Studies show that despite extensive drug therapy, hospitalization for the condition is pretty common. (2)
Of course, ketamine would not also cure the condition or prevent its attacks completely. However, it is relatively safe. Studies show that it is quite effective. Moreover, it is a safer option than lithium or antipsychotic drugs. Hence, ketamine provides hope to the patients living with the condition.
Benefits of Ketamine Therapy
In recent years, researchers have started testing some of the drugs that have been around for some time. These drugs are proven to be safe when used responsibly. One such option is ketamine, a pretty old anesthetic. Doctors have been using ketamine in anesthesia for more than half a century. It means that they know a lot about this drug, its possible side effects, and how to overcome its toxicity.
Ketamine is known to affect the so-called NMDA receptor antagonist. This means that it blocks those receptors. However, due to its much broader role in stabilizing mood, researchers think it also affects other brain receptors and may influence the level of various neurotransmitters.
Few things have amazed researchers about ketamine, and that is why they are recommending it so widely for bipolar disorders.
Just consider treatment with lithium or antipsychotic drugs. One would need to take these drugs for weeks to experience their benefits. Even worse, many may experience bipolar disorder signs and symptoms even while on these drugs.
However, ketamine is quite different and works pretty quickly. Many of those living with bipolar disorders can feel when they are going to have an attack due to some early signs like mild excitement, restlessness, and sleep changes. However, when these individuals are given ketamine infusion, it may help abort the attack. Yes, within a few minutes, one may feel relaxed. Just a single ketamine infusion may suppress bipolar symptoms.
Yet, another interesting thing about ketamine is that it can be used frequently, which means multiple infusions given at a specific interval, generally weekly. In severe cases or resistant patients, it may help stabilize the patient. So, there is a benefit of fewer dosages. Moreover, a single weekly infusion can ensure patient compliance.
However, there is more to ketamine therapy. It appears that sustained ketamine therapy may cause some brain changes. This brain rewiring may alter the course of the disease, and the condition may become less severe, something unseen with other medications. This is also one of the reasons for increasing interest in the therapy.
Further, ketamine makes patients more receptive to various instructions or psychotherapy. This means that ketamine is even more effective when used along with psychotherapy. Psychotherapy is safe to combine with it as it does not use any drugs. Instead, doctors teach patients how to identify triggers and control bipolar attacks without medications.
Since the condition is chronic, doctors would usually prefer weekly ketamine infusions. One would have to stay in a clinic for a few hours, and after that, one can return to one’s usual life. Although this is a minor downside of the therapy, then one does not have to worry about taking many medications daily. One can keep enjoying a relatively calm life for the rest of the week; moreover, after each infusion, one feels increasingly calm and relaxed.
How Good Is Ketamine?
Ketamine is wonderful in a way that it is good for both anxious and depressed patients. Studies show that it can help patients irrespective of their phase at any given time. It helps in most instances. The majority of patients report significant benefits from ketamine infusion when living with bipolar disorder.(3)
Ketamine is not yet fully US FDA-approved therapy for the condition. However, specialists can legally use it to manage various mental health issues. It is, of course, illegal to use ketamine at home to manage mental health issues. Moreover, it is a controlled substance. Further, it is worth noticing that in bipolar disorder, slow IV therapy works. Quick IV injection is not safe and may cause euphoria.
Over the years, much data has accumulated, and researchers have now been analyzing those studies to see how sound ketamine is for managing bipolar disorder. There is good news for those living with the condition since most studies show that it is quite effective. That is why the therapy has become so popular in recent times.
There have been few meta-analyses and systemic reviews in the last few years. These special kinds of studies combine data from multiple studies to understand how well any given therapy works. Systemic reviews help overcome study bias and other issues like the small sample size of specific studies.
Hence, researchers in 2015 did one systemic review. The study included five clinical trials with a total of 125 patients with bipolar disorder. These patients had a mean age of 44 years, and most of them were females. The study concluded that ketamine therapy offers hope for bipolar depression, especially for resistant cases and those living with suicidal ideation. Moreover, ketamine IV therapy does not appear to cause any severe long-term side effects.(4)
There has been another systemic review in 2021, which included six clinical trials with a total of 135 participants. All these studies used 0.5 mg/kg of add-on intravenous racemic ketamine. The study found that the response rate to ketamine therapy was 60% compared to a mere 5% in the placebo group. Ketamine was well-tolerated. However, one patient did develop manic symptoms even after the therapy. The therapy also causes dissociative symptoms for about 40 minutes.(5)
Of course, ketamine is not a panacea, and it only works in a little more than half of the cases. However, these are really good findings since most medical drugs have even worse responses. Moreover, in those, it works; it helps pretty quickly.
Of course, the above studies are not perfect and have many limitations. Most studies included in the systemic reviews had very few participants. It is regretful that most studies regarding ketamine use are pretty small, and there is still a need for more extensive clinical trials to appreciate its usefulness in the condition entirely. Nevertheless, results from these smaller studies have encouraging findings.
Ketamine May Be Suitable for Specific Groups of Patients
There are some other interesting findings regarding ketamine use in bipolar disorders. It appears it is even better for those with other health issues. Hence, one of the studies found that people living with obesity, high BMI, or a history of alcohol use respond better to therapy. Those with higher B12 levels, sleep issues, and higher antioxidant levels are more likely to benefit from ketamine therapy.(6)
Of course, these findings are fascinating. It is especially interesting to notice that obese individuals and alcohol addicts respond well to ketamine therapy. Further, it is interesting to note that those with higher antioxidant status (glutathione) and B12 levels respond better to the therapy. This means that the efficacy of the therapy can be enhanced by using certain dietary supplements.
Yet, another area that researchers are exploring is that some early studies show that ketamine is suitable for resistant cases. That is, even those who did not respond well to various medications have hope and they might respond well to ketamine treatment. This means that if one fails to benefit from other treatments, that is not a reason to refuse ketamine treatment for bipolar disorder.(7)
So, for those living with bipolar disorder, that is, millions of adults in the US, there is hope now. There is sound evidence from various clinical trials that this drug, which has already been in clinical use for more than half a century, can help with bipolar disorder. Moreover, it can help both during a manic attack and depression phase. Hence, one does not need to wait for some specific time to get started with the drug therapy.
Before we continue our discussion, a word of caution. Ketamine is a substance of abuse in the US. One should never use ketamine without medical supervision. Illicitly sold ketamine does not essentially have those health benefits, and even worse, it may cause significant harm. Further, it is worth noticing that all these benefits for mental health issues are associated with slow ketamine infusion and not tablets or rapid IV injections.
How Might Ketamine Help with Bipolar Disorder?
This is a poorly understood topic. Despite its availability for more than half a century, it is unclear how it works. Studies show that it works better for some individuals than others. They have also seen that higher activity of certain brain centers might help predict its effectiveness in specific groups of patients.
Science knows that it acts on NMDA receptors. However, like many other centrally-acting drugs, it also acts on many other receptors, such as serotonin, acetylcholine, dopamine, and much more. So, it is unclear how its impact on other brain receptors can influence its activity.(8)
Further, there are a few things that are difficult to understand. A single Ketamine injection can help suppress bipolar disorder for a week and, in many cases, for several weeks. However, ketamine stays in the body only for a few hours. It has a half-life of about 3 hours only.(8) It means that after eight hours, most of the ketamine has left the body or has been metabolized. However, its impact is felt for several days and weeks. This is clearly due to specific brain changes that occur due to ketamine. However, science does not know what those brain changes are.
Is Ketamine Safe?
Ketamine is safe, but not perfectly safe. That is why people are given ketamine infusion only in clinics. It is known to cause euphoria, especially when given a fast IV injection. At higher dosages, it is used as an anesthetic agent, which means that it makes a person unconscious and reduces pain sensation. Hence, it must always be used under medical supervision and at a specific dosage.
Since it causes dissociative symptoms like reduced consciousness, sense of time, and reduced mental abilities for short periods, people given ketamine therapy have to stay for a few hours after the treatment. Fortunately, most of these side effects are short-lived. Of course, it might cause other smaller issues like nausea, blurring of vision, vomiting, dizziness, and feelings of unease. However, these issues are generally over after a few hours.
So, it would be correct to say that ketamine, when used under medical supervision, is very safe. One can expect significant health benefits, yet few short-lasting side effects exist.
The Bottom Line
To sum up, although ketamine is not among the approved treatments for managing bipolar disorder, it is incredibly safe and effective. This drug has a long history of use in medicine as an anesthetic and even sometimes as a painkiller. Hence, there is a reason to consider using ketamine to manage bipolar disorder.
There are some strong reasons to recommend ketamine therapy. Firstly, though there are many drugs like lithium and antipsychotic medications for the condition, none are suitable for all patients, and they are pretty toxic. Some of these medications are far more toxic than ketamine.
Secondly, ketamine can also work for resistant cases. It means that it can help even those in whom other treatments have failed.
Thirdly, ketamine works pretty quickly. It is good for overcoming manic attacks or providing quick relief from depression. So, irrespective of the patient’s state of mind, it can provide quick relief in the majority of the cases, if not in all the cases.
Fourthly, it is also good for use as a maintenance treatment. Moreover, it has the benefit of a single procedure a week, which many patients may prefer. This may also ensure better patient outcomes due to higher treatment compliance. Further, ketamine has some long-term benefits, like its ability to alter brain structure. This means that its regular use for a long may alter the course of the disease.
Finally, it is also worth noticing that ketamine is incredibly safe. Of course, it causes dissociative symptoms, nausea, vomiting, and other issues, but those problems do not last long. Most of these unpleasant effects last for about a couple of hours, and after that, the person is good to return to a regular life. This is unlike antipsychotics, which might cause many severe and persistent side effects. Moreover, ketamine, unlike lithium or antipsychotics, does not cause organ toxicity (like liver or kidney issues) when used as recommended.
Of course, we end our article with a word of caution. Never use ketamine therapy at home. Only a trained healthcare provider must do it. Illicitly bought ketamine is a dangerous drug and should not be considered for managing health issues. Such drugs are more likely to cause harm due to impurities.
So, if you are living with bipolar disorder and are not satisfied with the treatment, then it is worth exploring ketamine therapy. It seems to do wonders for most patients.
References
- Bipolar Disorder – National Institute of Mental Health (NIMH) [Internet]. [cited 2024 Mar 2]. Available from: https://www.nimh.nih.gov/health/statistics/bipolar-disorder
- Lähteenvuo M, Tanskanen A, Taipale H, Hoti F, Vattulainen P, Vieta E, et al. Real-world Effectiveness of Pharmacologic Treatments for the Prevention of Rehospitalization in a Finnish Nationwide Cohort of Patients With Bipolar Disorder. JAMA Psychiatry. 2018 Apr 1;75(4):347–55.
- Ionescu DF, Luckenbaugh DA, Niciu MJ, Richards EM, Zarate Jr CA. A single infusion of ketamine improves depression scores in patients with anxious bipolar depression. Bipolar Disorders. 2015;17(4):438–43.
- Parsaik AK, Singh B, Khosh-Chashm D, Mascarenhas SS. Efficacy of Ketamine in Bipolar Depression: Systematic Review and Meta-analysis: Retracted. Journal of Psychiatric Practice®. 2015 Nov;21(6):427.
- Bahji A, Zarate CA Jr, Vazquez GH. Ketamine for Bipolar Depression: A Systematic Review. International Journal of Neuropsychopharmacology. 2021 Jul 1;24(7):535–41.
- Rong C, Park C, Rosenblat JD, Subramaniapillai M, Zuckerman H, Fus D, et al. Predictors of Response to Ketamine in Treatment Resistant Major Depressive Disorder and Bipolar Disorder. International Journal of Environmental Research and Public Health. 2018 Apr;15(4):771.
- Phillips JL, Norris S, Talbot J, Birmingham M, Hatchard T, Ortiz A, et al. Single, Repeated, and Maintenance Ketamine Infusions for Treatment-Resistant Depression: A Randomized Controlled Trial. AJP. 2019 May;176(5):401–9.
- Ketamine [Internet]. [cited 2024 Mar 2]. Available from: https://go.drugbank.com/drugs/DB01221
