Ketamine and other glutamate receptor modulators for depression in adults with bipolar disorder.
Cochrane Database of Systematic Reviews October 8, 2021 Rebecca L. Dean, Tahnee Marquardt, Claudia C. Hurducas et al. 41 citations
A Cochrane review of ten randomized controlled trials (647 participants) examined glutamate receptor modulators for bipolar depression. Only ketamine appeared more effective than placebo for response rate 24 hours after a single intravenous dose, but evidence was low-certainty and limited to two small trials. Ketamine did not show better remission rates than placebo. Evidence for other modulators—memantine, cytidine, N-acetylcysteine, and riluzole—was insufficient or showed no benefit. The review concludes that while ketamine may have a rapid, transient antidepressant effect, the evidence is too uncertain to draw reliable conclusions, and more rigorous studies are needed.