Neuropsychiatric Disease and Treatment
November 1, 2020
Alina Wilkowska, Łukasz P. Szałach, Wiesław Jerzy Cubała
31 citations
Bipolar disorder is a psychiatric illness with high morbidity, mortality, and suicide rates, a neuroprogressive course, and frequent treatment resistance, creating a need for new treatment strategies. Ketamine appears to have rapid antidepressive and antisuicidal effects. Because most available studies concern unipolar depression, this article presents a novel argument that ketamine might be a promising treatment for bipolar disorder.
European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology
September 1, 2024
Aleksander Kwaśny, Julia Kwaśna, Alina Wilkowska et al.
24 citations
Ketamine, a medication used for depression, may also reduce anhedonia (loss of interest or pleasure). A systematic review of 22 studies (4 randomized-controlled trials and 18 open-label trials) found that all reported alleviation of anhedonia symptoms after ketamine or esketamine administration, regardless of the number of infusions. Neuroimaging studies showed changes in functional connectivity linked to improvement. However, limitations include few placebo-controlled trials. The review suggests a potential anti-anhedonic effect of ketamine in depressed patients, likely through neuroplastic changes.
Cells
February 12, 2022
Alina Wilkowska, Mariusz S. Wiglusz, Katarzyna Jakuszkowiak‐wojten et al.
23 citations
A review of animal and human studies on combining ketamine with lamotrigine found that animal models suggested a synergistic antidepressant effect, while studies in healthy humans showed lamotrigine pretreatment reduced ketamine-induced dissociative symptoms. In a study of depressed patients, a single ketamine infusion combined with lamotrigine did not produce a stronger antidepressant effect than ketamine alone. A case series described antidepressant and anti-suicidal effects in two bipolar patients. Clinical studies in mood disorder patients did not support lamotrigine reducing ketamine-induced dissociation. The available evidence was insufficient to answer the review's questions, but pointed to future research directions, including controlled studies in bipolar patients with multiple ketamine infusions.
Bipolar Disorders
February 4, 2024
Alina Wilkowska, Mariusz S. Wiglusz, Aleksandra Arciszewska et al.
17 citations
In patients with treatment-resistant bipolar depression, adding ketamine infusions to ongoing treatment reduced anhedonia, a debilitating symptom linked to suicidality and poor treatment response. Improvement was seen on both patient-reported and clinician-rated measures of anhedonia, and anxiety and mood/cognition symptoms also improved, but sleep symptoms did not. No serious adverse events occurred. The findings suggest ketamine may be a useful option for anhedonia in this population, though further research is needed.
International Journal of Molecular Sciences
November 23, 2022
Alina Wilkowska, Wiesław Jerzy Cubała
17 citations
Treatment-resistant depression affects about 30% of people with depression, and the likelihood of remission drops with each subsequent episode. This condition contributes heavily to global disease burden, raises morbidity and mortality, and lowers quality of life. It involves repeated difficult-to-treat episodes, with resistance growing over time. Staging captures how these changes lead to worsening treatment resistance and overall functioning. Ketamine, a rapid-acting antidepressant that can promote neuroplasticity, is argued here to be able to reverse this worsening process when used as an add-on treatment, offering hope and countering therapeutic nihilism.
Frontiers in psychiatry
January 1, 2024
Aleksander Kwaśny, Alina Wilkowska, Wiesław Jerzy Cubała
10 citations
A systematic review of clinical trials on 5-MeO-DMT, an atypical psychedelic being studied as a rapid-acting antidepressant, found that the drug has a good short-term safety and tolerability profile. Three trials involving 78 participants (two with healthy volunteers, one with treatment-resistant depression patients) reported no serious adverse events and no drop-outs. The authors conclude that 5-MeO-DMT administration in humans is safe in the short term, but call for larger, placebo-controlled trials with longer follow-up to assess potential chronic adverse events.
Frontiers in Psychiatry
December 8, 2023
Alina Wilkowska, Wiesław Jerzy Cubała
10 citations
Bipolar depression is a serious psychiatric condition linked to high suicide risk, treatment resistance, chronicity, and poor quality of life. Approved treatments are limited and often insufficient, creating an urgent need for new strategies. Intranasal esketamine, a ketamine enantiomer, is a rapid-acting antidepressant proven effective for treatment-resistant depression. Research on bipolar depression, though less extensive, suggests esketamine may be a safe alternative with low risk of mood polarity shifts. Reports indicate ketamine treatment may reduce suicidal thoughts, anhedonia, and anxiety. Ketamine's potential mood-stabilizing properties are hypothesized. This narrative review examines ketamine as an add-on to standard medication for acute bipolar depression.
The World Journal of Biological Psychiatry
June 20, 2023
Maria Gałuszko‐węgielnik, Katarzyna Jakuszkowiak‐wojten, Alina Wilkowska et al.
9 citations
A woman with both bipolar disorder and borderline personality disorder received intravenous ketamine for acute depression. While ketamine initially improved her depressed mood, continued treatment led to increased nonsuicidal self-injury, impulsive behavior, and worsening dissociative symptoms. Treatment was stopped and replaced with a different medication that proved helpful. The authors conclude that ketamine's effects on emotional dysregulation and impulsivity are unclear and differ from its antidepressant effects, highlighting the need for more safety and effectiveness studies in this patient group.
Frontiers in Psychiatry
June 3, 2020
Alina Wilkowska, Łukasz P. Szałach, Jakub Słupski et al.
9 citations
Ketamine can rapidly reduce depression in people with treatment-resistant bipolar disorder, but it also carries a risk of triggering mania. This case describes a patient with bipolar I disorder who, after eight low doses of oral ketamine added to their usual treatment, switched from a depressive episode to a manic episode with mixed features. The manic symptoms began two days before the switch became full-blown. The finding highlights the need for careful monitoring of mood changes when using ketamine in bipolar depression.
Frontiers in Psychiatry
December 2, 2021
Maria Gałuszko‐węgielnik, Adam Włodarczyk, Wiesław Jerzy Cubała et al.
5 citations
Repeated series of intravenous ketamine infusions, given as an add-on treatment, can be effective and safe for patients with treatment-resistant depression. In a case series of five inpatients aged 43–63 with major depressive disorder or bipolar I disorder, four achieved remission after the first series of eight infusions, and three after the second series. Adverse reactions were mild and transient. The results are limited to short-term, add-on intravenous ketamine and cannot be generalized to long-term maintenance or other formulations.
Pharmacological reports : PR
December 1, 2024
Julia Kwaśna, Wiesław Jerzy Cubała, Aleksander Kwaśny et al.
4 citations
Intravenous ketamine at 0.5-1.0 mg/kg based on actual body weight is effective for treatment-resistant depression. In a retrospective analysis of 28 inpatients with treatment-resistant major depressive disorder, alternative dosing formulas using lean body mass, ideal body weight, or body surface area generally led to underdosing compared to the standard 0.5 mg/kg dose. Only two participants received higher doses when using the Devine formula. The findings suggest that alternative dosing methods may reduce treatment response and complicate outcome interpretation. Future studies should incorporate direct body composition measures like bioimpedance and waist-to-hip ratio.
Pharmacol Rep
May 20, 2026
Aleksander Kwaśny, Alina Wilkowska, Michał Pastuszak et al.
A retrospective analysis of patient-reported outcomes found that psychiatric adverse events emerged during ketamine treatment for major depressive disorder. The text does not specify the frequency, severity, or nature of these events, nor does it provide comparative data or a control group. The analysis suggests that such events can occur, but the magnitude and clinical significance remain unclear based solely on the abstract.
Therapeutic advances in psychopharmacology
January 1, 2025
Aleksander Kwaśny, Wiesław Jerzy Cubała, Alina Wilkowska
Intravenous ketamine is effective for treatment-resistant bipolar depression, with dosing typically based on actual body weight. In a retrospective analysis of 22 inpatients, doses recalculated using formulas for lean body mass, ideal body weight, and body surface area were compared between responders and nonresponders. Body surface area-normalized doses ranged from 17.63 to 23.09 mg/m² in nonresponders and 15.73 to 23.89 mg/m² in responders. Lean body mass and ideal body weight recalculations at 0.5 mg/kg yielded lower relative doses, especially among nonresponders, suggesting potential underdosing. These preliminary findings do not support alternative dosing formulas over actual body weight, but replication in larger controlled studies is warranted.