New pharmacotherapies to tackle the unmet needs in bipolar disorder: a focus on acute suicidality.
Expert opinion on pharmacotherapy March 1, 2024 Georgios D Kotzalidis, Federica Fiaschè, Alessandro Alcibiade et al. 3 citations
Suicidal behavior is common among people with bipolar disorder and is the leading cause of death in this group, with rates remaining high despite standard treatments like lithium, antidepressants, and psychotherapy. A review of PubMed identified few studies on acute suicidality and lithium or clozapine, but 14 studies on ketamine, esketamine, or glutamate-related treatments. Glutamatergic abnormalities are present in both bipolar disorder and suicide. The NMDA antagonist ketamine and its S-enantiomer esketamine appear to decrease acute suicidality, possibly by rapidly remodeling glutamate activity. Intranasal esketamine or subcutaneous ketamine, and possibly other glutamate receptor modulators, may improve suicidal behavior in unipolar and bipolar depression, suggesting glutamatergic modulators could reduce acute suicidality and mortality in bipolar disorder.