Efficacy and safety of ketamine in bipolar depression : A systematic review, Susana Alberich et al., 2017

Efficacy and safety of ketamine in bipolar depression : A systematic review

Susana Alberich, Mónica Martínez-Cengotitabengoa, Purificación López, Inaki Zorrilla, Nuria Núnez, Eduard Vieta, Ana González-Pinto,

Review Psiquiatrica Salud Mental, 2017, 10, 2, 104-112.

2173-5050/© 2016 SEP y SEPB. Published by Elsevier Espana, S.L.U. All rights reserved.

KEYWORDS : Bipolar depression; Ketamine; Efficacy

Abstract :

The depression is the most prevalent state throughout the life of the bipolar patient. Ketamine has been shown to be an effective and rapid treatment for depression. The objective of the present work is to perform a systematic review on the efficacy and safety of ketamine as treatment of bipolar depression, as well as its different patterns of administration. The search found 10 relevant manuscripts that met the inclusion criteria: one clinical trial, 5 cohort studies, and 4 case reports. Intravenous infusion was used in 60% of the studies. According to data, ketamine seems to be an effective and safe treatment for bipolar depression, although the length of its effect is short. Adverse effects observed generally occurred at the time of infusion, and tended to completely disappear within 1-2 h. Therefore, more studies are necessary to explore new patterns of administration, as well as on its safety and adverse effects.

Introduction :

Bipolar disorder (BD) is one of the most incapacitating medical diseases and it is also one of the most costly for the healthcare system.(1) Depression, dysthimia and mixed states as a whole are the most prevalent components of BD.(2) Although effective treatments for bipolar depression exist, (3-6) a significant number of cases are resistant due to lack of efficacy or intolerance of side effects. There is therefore a major need to develop new drugs with a rapid antidepressive effect, given the risk of suicide among these patients.(7)

During the last decade, several studies have shown that the glutamatergic system and most particularly the N-methyl-d-aspartate receptor (NMDA) are involved in the efficacy of antidepressive treatments, which makes it a target for the development of new treatments.(7) Ketamine is a phencyclidine derivate and NMDA receptor antagonist which has been shown to have a swift and potent effect against depressive episodes at sub-anaesthetic doses.(8,9) In the case of unipolar depression at least 8 clinical trials have been published that showed ketamine to be fast-acting and effective in this diagnostic group (10-17).

This review has the aim of systematically analysing and summarising the scientific evidence of the most recent works on the efficacy and safety of using ketamine to treat bipolar depression, as well as its different forms of administration.