Adjunctive music improves the tolerability of intravenous ketamine for bipolar depression

Summary

Intravenous ketamine effectively treats bipolar depression, but its side-effect of dissociation can be distressing and treatment-limiting. Two patients with bipolar 1 disorder and severe depression received their first ketamine infusion without music and chose music for subsequent infusions. They reported that music improved tolerance of dissociative symptoms, reducing distress and aiding further treatments. Both achieved remission from treatment-resistant depression after six infusions. This is the first report of music's benefits with ketamine for bipolar 1 depression, building on prior research with psychedelics. Principles of music selection from that paradigm may apply to unipolar and bipolar depression, warranting further research.

Study at a glance

Abstract

Intravenous ketamine is an effective treatment of bipolar depression. One of its most important side-effects is a transient altered state of consciousness commonly referred to as dissociation. These states can be anxiety-provoking, distressing and even treatment-limiting, warranting research into mitigation strategies. In this article, we present two cases that demonstrate the potential of adjunctive music to diminish the distress associated with ketamine-induced dissociation – though not necessarily its degree – in bipolar 1 disorder. Both patients suffering from severe depression underwent their first ketamine infusion without music and opted for music with subsequent infusions. They reported that music significantly improved the tolerance of their dissociative symptoms, thereby reducing distress and facilitating subsequent treatments. Both patients achieved remission from their highly treatment-resistant depressive episodes following six ketamine infusions. This is the first report of music’s benefits on ketamine for bipolar 1 depression, though there is precedence in the scientific literature on ‘psychedelics’ where the use of music in combination with medication-induced altered states has been studied. The principles regarding music selection that have resulted from this paradigm may be applicable to the use of ketamine in unipolar and bipolar depression. The optimal use of music with ketamine warrants further research.