Brain Sciences
January 13, 2023
Maria Gałuszko‐węgielnik, Zuzanna Chmielewska, Katarzyna Jakuszkowiak‐wojten et al.
20 citations
Psychotic treatment-resistant depression is a severe form of major depressive disorder involving hallucinations or delusions, often underdiagnosed and undertreated. Ketamine has shown rapid antidepressant effects, and its enantiomer esketamine was approved for treatment-resistant depression in 2019. This report describes four inpatients with treatment-resistant depression and psychotic features, including one in severe suicidal crisis, who received a single 0.5 mg/kg intravenous infusion of ketamine as an add-on to standard care. Monitoring showed no worsening of psychotic symptoms in short or long term, and all patients achieved stable remission with an immediate antisuicidal effect. Ketamine may benefit individuals with this condition.
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.
Neuropsychiatric Disease and Treatment
October 1, 2020
Joanna Szarmach, Wiesław Jerzy Cubała, Adam Włodarczyk et al.
15 citations
In patients with treatment-resistant depression, intravenous ketamine is generally safe and well-tolerated when added to existing psychiatric medications. Blood pressure and heart rate returned to baseline within 90 minutes after each infusion, with no lasting complications. However, larger temporary increases in blood pressure occurred in patients also taking SSRIs, and heart rate decreases were greater in those not taking mood stabilizers. Risks were more pronounced in patients with coexisting high blood pressure or diabetes. The study included 35 people with major depressive disorder and 14 with bipolar disorder.
Medicina
March 16, 2021
Joanna Szarmach, Wiesław Jerzy Cubała, Adam Włodarczyk et al.
14 citations
Ketamine treatment for treatment-resistant depression has a good safety and tolerability profile, but patients with metabolic and cardiovascular comorbidities require risk mitigation. In a naturalistic observational study of 49 inpatients with major depressive disorder or bipolar disorder, those with hypertension showed a greater increase in systolic blood pressure after the second infusion compared to those without hypertension. Patients with diabetes mellitus had significant differences in heart rate after infusions 2, 7, and 8, and a higher increase in diastolic blood pressure. Hyperlipidemic patients experienced a greater decrease in heart rate after infusion 5 and systolic blood pressure after infusion 4. Stroke survivors had higher increases in diastolic blood pressure after infusions 4 and 6. Epilepsy patients had a greater decrease in systolic blood pressure after the 8th infusion.
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 Neuroscience
July 11, 2023
Maria Gałuszko‐węgielnik, Katarzyna Jakuszkowiak‐wojten, Mariusz S. Wiglusz et al.
8 citations
In patients with treatment-resistant unipolar or bipolar depression with psychotic features, eight intravenous infusions of 0.5 mg/kg ketamine given twice a week over 4 weeks did not worsen psychotic or dissociative symptoms. No statistically significant changes occurred in depressive, dissociative, or psychomimetic symptom scores across the whole group during treatment. However, within the unipolar and bipolar subgroups separately, significant improvements in these symptom scores were observed. The findings support the safety and tolerability of ketamine in this population, showing no exacerbation of psychotic symptoms.
Therapeutic Advances in Psychopharmacology
January 1, 2021
Adam Włodarczyk, Wiesław Jerzy Cubała, Maria Gałuszko‐węgielnik et al.
8 citations
In treatment-resistant inpatients with major depressive disorder (MDD) or bipolar disorder (BP), intravenous ketamine was generally well-tolerated with no lasting neurological harm. However, certain concurrent medications were linked to more psychomimetic and dissociative symptoms. Patients taking the antidepressant citalopram reported greater psychomimetic effects. Classic mood stabilizers—lamotrigine, valproate, and lithium—were each significantly associated with increased scores on the Brief Psychiatric Rating Scale. No long-term adverse effects were observed. The findings suggest that ketamine treatment requires careful monitoring for dissociative and psychomimetic symptoms, especially when combined with specific psychotropic drugs.
Magnesium Research
April 1, 2018
Natalia Górska, Wiesław Jerzy Cubała, Jakub Słupski et al.
8 citations
Depression is a leading cause of disability, and many adults with major depression do not achieve remission with first-line treatments. Magnesium influences several neurotransmitter systems involved in emotional processes, including serotonergic, noradrenergic, dopaminergic, GABAergic, and glutamatergic systems. The mechanism of antidepressants' action involves the glutamatergic system, and magnesium ions may play a role in major depressive disorder pathophysiology by blocking the N-methyl-D-aspartate receptor (NMDAR). Ketamine, an NMDAR antagonist, has fast-acting antidepressant and antisuicidal effects. The evidence discussed suggests a possible synergistic interaction between magnesium and ketamine's pharmacodynamic activity in mood disorders.
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.
Pharmaceuticals
May 3, 2021
Natalia Górska, Wiesław Jerzy Cubała, Jakub Słupski et al.
2 citations
Magnesium levels in the blood change over the course of ketamine treatment for depression. In patients with major depressive disorder or bipolar disorder, serum magnesium concentration was significantly higher before treatment began than after five or seven ketamine infusions. However, changes in magnesium levels were not correlated with depression scores on the Montgomery-Åsberg Depression Rating Scale (MADRS) or with mania scores on the Young Mania Rating Scale (YMRS). The study also found no link between magnesium concentration and somatic comorbidities. While the findings support the idea that magnesium plays a role in treatment-resistant depression, especially with ketamine, there is no clear evidence of a straightforward relationship between magnesium levels and treatment response or other health conditions.