Original Research J Clin Psychiatry October 2024

Efficacy and Safety of Ketamine/Esketamine in Bipolar Depression in a Clinical Setting

JCP 2024;85(4):10.4088/JCP.24m15376

Full Article Read the complete peer-reviewed article in J Clin Psychiatry. Clinical Summary Patients with bipolar disorder spend far more time depressed than manic, yet bipolar depression remains difficult to treat and antidepressants carry both limited efficacy and concern for affective switch. This report addresses a practical question many clinicians face in refractory bipolar depression: whether ketamine or esketamine can improve depressive symptoms in routine care without triggering early mania. FAQ How effective were ketamine and esketamine for bipolar depression in this clinical cohort?

Key Takeaways In the 38 patients with outcome data, depressive symptoms improved substantially across the acute series, with mean MADRS scores decreasing from 31.1 to 19.2 and mean QIDS scores decreasing from 17.8 to 10.7, supporting measurable benefit even in a clinically heterogeneous, treatment-resistant bipolar depression sample. Clinical Guide How should clinicians structure an off-label ketamine or esketamine treatment course for patients with bipolar depression in a clinical setting? Clinical Guide How should clinicians monitor for hypomania or mania during continuation or maintenance ketamine or esketamine treatment for bipolar depression?