Health Technology Brief

supporting sound, evidence-based decision making

Ketamine Infusion for Treatment-Resistant Bipolar Depression

December 7, 2017

Health Problem: Bipolar disorder is a chronic illness characterized by alternating periods of profound depression and excessively elevated or irritable mood (mania). These episodes of extreme mood are interspersed by periods of relatively normal mood. Bipolar disorder is a severely impairing illness associated with unemployment, decreased productivity, and excess mortality.

Technology Description: Ketamine therapy for bipolar disorder often involves infusing a sub-dissociative dose of ketamine hydrochloride intravenously. Patients are awake during the procedure, but an anesthesiologist or other qualified healthcare professional is often present for patient monitoring since ketamine is typically used as a dissociative anesthetic. Pretreatment workup may include psychological testing and treatment history, pregnancy testing, and toxicology screening since ketamine can interact with other drugs. There is little postinfusion care beyond monitoring for psychotomimetic effects and holding for observation if the side effects are severe. Multiple ketamine infusion sessions may be necessary.

Controversy: The available medications for bipolar disorder have limited effect during a depressive phase and carry some safety concerns. Ketamine represents a safe drug that can rapidly reduce depressive symptoms and may be a viable option for bipolar patients during a severe depressive phase. Bipolar patients need to be monitored closely following infusion of ketamine because the relief of depressive symptoms may trigger a manic episode.

Key Questions

  • Does ketamine reduce or eliminate the symptoms of treatment-resistant bipolar depression?
  • How does ketamine compare with other strategies for treating treatment-resistant bipolar depression?
  • Is ketamine a safe therapy for treatment-resistant bipolar depression?
  • Have definitive patient selection criteria been established for use of ketamine as a therapy for treatment-resistant bipolar depression?