Real‐world effectiveness of repeated ketamine infusions for treatment‐resistant bipolar depression

Dec 14, 2022Bipolar disorders

Repeated ketamine infusions and their real-world effects on hard-to-treat bipolar depression

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Abstract

A mean reduction of 6.08 in depression symptoms was noted after four ketamine infusions in 66 patients with treatment-resistant bipolar depression.

Statistically and clinically significant antidepressant effects were observed as measured by the Quick Inventory for Depression Symptomatology-Self Report-16 (QIDS-SR).
Further reductions in depressive symptoms occurred after each subsequent infusion.
Reductions in suicidal thoughts and anxiety were also significant, along with functional improvements.
The response rate for a decrease of 50% or more in total depression score was 35%, while the remission rate was 20% after four infusions.
Infusions were generally well tolerated, with hypomania occurring in only three patients (4.5%) and no cases of mania or psychosis.

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BACKGROUND: Clinical trials have demonstrated rapid antidepressant effects with intravenous (IV) ketamine for major depressive disorder, with relatively less research specifically for bipolar depression. Herein, we describe the real-world effectiveness of repeated ketamine infusions for treatment-resistant bipolar depression.

METHODS: This study was conducted in a community clinic in Mississauga, Ontario (Canadian Rapid Treatment Centre of Excellence; Braxia Health). In this observational study (NCT04209296), patients with treatment-resistant bipolar I/II depression (n = 66) received four sub-anesthetic doses of IV ketamine (0.5-0.75 mg/kg) over a two-week period. Symptoms of depression, suicidality, anxiety, and functioning were assessed with validated self-report measures.

RESULTS: Statistically and clinically significant antidepressant effects were observed in the overall sample, as measured by the Quick Inventory for Depression Symptomatology-Self Report-16 (QIDS-SR) with further reductions in depressive symptoms observed after each subsequent infusion (n = 66; mean QIDS-SRreduction of 6.08+/-1.39; p < 0.0001). Significant reductions of suicidal thoughts (QIDS-SR-Suicide Item) and anxiety (Generalized Anxiety Disorder-7) were also observed with functional improvements on the Sheehan Disability Scale (p < 0.0001 on all measures). Moreover, the response rate (QIDS-SRtotal score decrease ≥50% from baseline) was 35% and remission rate (QIDS-SRtotal score ≤5) was 20% after four infusions. Infusions were generally well tolerated with treatment-emergent hypomania observed in only three patients (4.5%) with zero cases of mania or psychosis. 16 16 16 16 16

CONCLUSIONS: Real-world effectiveness of IV ketamine for bipolar depression was observed. Repeated doses were associated with greater symptom reduction and adequate tolerability.

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Real‐world effectiveness of repeated ketamine infusions for treatment‐resistant bipolar depression

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