Ketamine augmentation rapidly improves depression scores in inpatients with treatment-resistant bipolar depression

Rybakowski, Janusz; Permoda-Osip, Agnieszka; Bartkowska-Śniatkowska, Alicja

doi:10.1080/13651501.2017.1297834

Cited by 38 publications

(29 citation statements)

References 22 publications

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“…Our findings bear directly upon discrepancies in the literature whether ketamine has greater, lesser, or no different effect in men and women. The day of injection might greatly influence the acute benefits of ketamine and differences in treatment timing might explain the great variability (anywhere from 40 to 80%) across clinical trials, including a recent report of only 43% of women showing improvement after ketamine infusion [76]. Increased understanding of these mechanisms with regard to sex differences will help develop tailored therapies and identify new risk and/or protective factors for psychiatric disorders.…”

Section: Discussionmentioning

confidence: 99%

NMDA 2A receptors in parvalbumin cells mediate sex-specific rapid ketamine response on cortical activity

et al. 2019

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Ketamine has emerged as a widespread treatment for a variety of psychiatric disorders when used at sub-anesthetic doses, but the neural mechanisms underlying its acute action remain unclear. Here, we identified NMDA receptors containing the 2A subunit (GluN2A) on parvalbumin (PV)-expressing inhibitory interneurons as a pivotal target of low-dose ketamine. Genetically deleting GluN2A receptors globally or selectively from PV interneurons abolished the rapid enhancement of visual cortical responses and gamma-band oscillations by ketamine. Moreover, during the follicular phase of the estrous cycle in female mice, the ketamine response was transiently attenuated along with a concomitant decrease of grin2A mRNA expression within PV interneurons. Thus, GluN2A receptors on PV interneurons mediate the immediate actions of low-dose ketamine treatment, and fluctuations in receptor expression across the estrous cycle may underlie sex-differences in drug efficacy.

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Section: Discussionmentioning

confidence: 99%

NMDA 2A receptors in parvalbumin cells mediate sex-specific rapid ketamine response on cortical activity

et al. 2019

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“…Patients treated with ketamine were medication-free in some studies 6,31 ; ongoing medications were continued unchanged in others. 8,32 In this context, a suggestion that psychiatrists can consider is to continue necessary antidepressant and other medications during a ketamine trial, especially because maintenance antidepressant treatment will be required should the patient respond or remit. With specific reference to diagnostic subgroups, patients could need mood stabilizer and/or antipsychotic medication when the illness being treated is bipolar depression or depression with psychotic symptoms.…”

Section: Parting Notes: Use Of Concurrent Medications During a Ketamimentioning

confidence: 99%

Ketamine for Depression, 2: Diagnostic and Contextual Indications

Andrade

2017

J. Clin. Psychiatry

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There is a substantial body of literature comprising anecdotal material and descriptions of uncontrolled and randomized controlled trials addressing the use of subanesthetic doses of ketamine for the off-label treatment of major depressive episodes. This article examines diagnostic indications for the off-label use of ketamine as an antidepressant and possible contexts in which ketamine may be trialled. Ketamine is indicated in patients who are in a major depressive episode. Most of the research data have been collected from patients with major depressive disorder, but patients with bipolar depression have also been studied. Ketamine is effective in both diagnostic groups, but its benefits are impermanent, perhaps more so in bipolar depression. There are several contexts within this diagnostic framework when a ketamine trial may be considered. These include severe depression and depression that is refractory to conventional antidepressant medication; this is because there is little purpose in trialling an experimental treatment in patients who are less severely ill and those who are antidepressant responsive. More importantly, ketamine has demonstrated efficacy in the rapid reduction of suicidal symptoms and can therefore be trialled when rapid reduction in suicidality is necessary. Likewise, because of its swift and dramatic antidepressant action, it can be trialled in patients in whom improvement is urgently desired in order to allow the patient to attend to pressing life circumstances. Some data suggest that the use of ketamine early during the course of an antidepressant trial, or as anesthesia during electroconvulsive therapy, can improve early antidepressant outcomes. It is not clear whether the presence of psychotic symptoms is a contraindication for ketamine use. Issues related to these indications and contexts are briefly discussed.

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“…13 In an open-label study of 42 patients with bipolar depression, Permoda-Osip et al found that 52% responded to a single infusion of ketamine; 14 the rapid antidepressant effect was replicated in a subsequent study conducted among 53 patients with bipolar depression. 15 In another study, 23 and 4 patients with unipolar and bipolar depression, respectively, were administered esketamine (0.25mg/ kg); almost half of the patients (48.1%) showed a response within 1 week of treatment. Ten patients (37.0%) experienced remission in the same period.…”

Section: Introductionmentioning

confidence: 99%

<p>Ketamine in Bipolar Disorder: A Review</p>

Wilkowska¹,

Szałach²,

Cubała³

2020

NDT

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Bipolar disorder (BD) is a psychiatric illness associated with high morbidity, mortality and suicide rate. It has neuroprogressive course and a high rate of treatment resistance. Hence, there is an unquestionable need for new BD treatment strategies. Ketamine appears to have rapid antidepressive and antisuicidal effects. Since most of the available studies concern unipolar depression, here we present a novel insight arguing that ketamine might be a promising treatment for bipolar disorder.

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Ketamine augmentation rapidly improves depression scores in inpatients with treatment-resistant bipolar depression

Abstract: The results confirm a rapid antidepressant effect of ketamine infusion in a considerable proportion of those patients with bipolar depression receiving mood-stabilising drugs. Apart from male gender, no other clinical factors were predictors of response.

Cited by 38 publications

References 22 publications

NMDA 2A receptors in parvalbumin cells mediate sex-specific rapid ketamine response on cortical activity

NMDA 2A receptors in parvalbumin cells mediate sex-specific rapid ketamine response on cortical activity

Ketamine for Depression, 2: Diagnostic and Contextual Indications

<p>Ketamine in Bipolar Disorder: A Review</p>

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