Safety and Tolerability of Ketamine Use in Treatment-Resistant Bipolar Depression Patients with Regard to Central Nervous System Symptomatology: Literature Review and Analysis

Summary

Current treatments for major depression focus on monoaminergic drugs, which fail many patients. Treatment-resistant bipolar depression (TRBD) affects up to 33% of treated depressive patients. Ketamine, an NMDA receptor antagonist, shows promise, with effects emerging minutes to hours after a single dose. However, little data exist on ketamine's performance in TRBD patients with somatic comorbidities like cardiovascular disease, diabetes, obesity, stroke, epilepsy, or in the elderly. The literature indicates ketamine is efficacious and safe; most adverse drug reactions are mild and resolve within 30 minutes to 2 hours of administration.

Study at a glance

Abstract

The current psychopharmacological treatment approaches for major depression focus on monoaminergic interventions, which are ineffective in a large proportion of patients. Globally, treatment-resistant bipolar depression (TRBD) affects up to 33% of depressive patients receiving treatment. Certain needs are still unmet and require new approaches. Many studies are in favor of treatments with ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist, even in single use, whose effects emerge in minutes to hours post administration. However, little data are available on ketamine performance in TRBD patients with somatic comorbidities, including highly prevalent ones, i.e., cardiovascular disease (heart failure, hypertension, post-myocardial infarct, arrhythmias, etc.) diabetes, and obesity, and depression-associated comorbidities such as stroke, epilepsy, as well as in the elderly population. The literature shows that treatment with ketamine is efficacious and safe, and the majority of adverse drug reactions are mild and tend to mostly disappear within 30 min to 2 h of ketamine administration.