Intravenous ketamine effectively treats bipolar depression, but its side-effect of dissociation can be distressing and treatment-limiting. Two patients with bipolar 1 disorder and severe depression received their first ketamine infusion without music and chose music for subsequent infusions. They reported that music improved tolerance of dissociative symptoms, reducing distress and aiding further treatments. Both achieved remission from treatment-resistant depression after six infusions. This is the first report of music's benefits with ketamine for bipolar 1 depression, building on prior research with psychedelics. Principles of music selection from that paradigm may apply to unipolar and bipolar depression, warranting further research.
For people with treatment-resistant depression who did not benefit from transcranial magnetic stimulation (TMS), intravenous racemic ketamine may offer some help. In a small case series of 21 patients, a course of six ketamine infusions over two weeks was safe and produced few side effects. Average depression scores, measured by the MADRS scale, fell from 27.6 (moderate depression) to 18.6 (mild depression), a mean improvement of 34.5%. Four patients (19%) responded to treatment, and two of those (9.5%) achieved remission. The study was uncontrolled and retrospective, so results are preliminary.