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Beyond Mood Swings: Ketamine Therapy for Bipolar Disorder

by | Sep 28, 2024 | bi polar, Ketamine Therapy

Ketamine Therapy for Bipolar

Ketamine is a dissociative anesthetic, which has emerged as a potential game-changer in the treatment of depression.  This is true particularly for patients who have not responded well to traditional antidepressants.  The most common question we hear from patients and providers about ketamine therapy for bipolar disorder is:

“We know ketamine works for depression, but does it work for bipolar disorder specifically?”

The short answer is a definite YES.  Our longer answer emphasizes that there are two main types of bipolar disorder.  It’s important to distinguish between the two and adjust treatment plans accordingly.

What is Bipolar Disorder?

Bipolar disorder is a mental health condition characterized by significant mood swings that include emotional highs (mania or hypomania) and lows (depression). There are two main types of bipolar disorder: Bipolar I and Bipolar II. While they share some common features, there are key differences between the two types.

Bipolar I Disorder

    1. Manic Episodes: The hallmark of Bipolar I is the presence of at least one manic episode. Manic episodes are characterized by a distinct period of elevated, expansive, or irritable mood, lasting at least one week (or any duration, if hospitalization is required) and accompanied by symptoms such as increased energy, racing thoughts, grandiosity, decreased need for sleep, talkativeness, distractibility, and involvement in risky behaviors.
    2. Depressive Episodes: Most people with Bipolar I also experience depressive episodes, which involve symptoms such as persistent sadness, loss of interest in activities, changes in appetite or sleep patterns, fatigue, and feelings of worthlessness or guilt. It’s important to remember that the defining feature of Bipolar I is the occurrence of manic episodes, not depressive episodes.
    3. Severity: Manic episodes in Bipolar I can be severe and may require hospitalization to prevent harm. They can lead to significant impairment in social, occupational, or other important areas of functioning.
    4. Course of Illness: The course of Bipolar I can be highly variable, with individuals experiencing a mix of manic and depressive episodes, or even mixed episodes where symptoms of both mania and depression occur simultaneously.

Bipolar II Disorder

    1. Hypomanic Episodes: Bipolar II is characterized by at least one hypomanic episode. Hypomania is similar to mania but less severe. It involves a period of elevated or irritable mood lasting at least four days, with symptoms such as increased energy and activity levels, but without the significant functional impairment or psychotic features associated with mania.
    2. Depressive Episodes: Individuals with Bipolar II experience at least one major depressive episode, similar to the depressive symptoms seen in Bipolar I. These episodes can be severe and cause significant distress or impairment in functioning.
    3. No Full Manic Episodes: Unlike Bipolar I, Bipolar II does not involve full manic episodes. If a person experiences a manic episode, the diagnosis would be changed to Bipolar I.
    4. Course of Illness: Bipolar II often involves more frequent depressive episodes compared to Bipolar I. Hypomanic episodes in Bipolar II can be less disruptive than manic episodes in Bipolar I, but the depressive episodes can be severely debilitating.

Key Differences

    • Mania vs. Hypomania: The primary distinction is that Bipolar I involves manic episodes, which are more severe and disruptive, while Bipolar II involves hypomanic episodes, which are less intense and do not cause the same level of functional impairment.
    • Severity and Impact: Manic episodes in Bipolar I can be severe and may lead to hospitalization, whereas hypomanic episodes in Bipolar II are less severe and do not usually necessitate hospitalization.
    • Diagnosis: A diagnosis of Bipolar I requires at least one manic episode, whereas Bipolar II is diagnosed based on the presence of hypomanic episodes and at least one major depressive episode, without any history of manic episodes.

Ketamine Therapy for Bipolar Disorder

Studies have demonstrated that ketamine has significant

Ketamine is thought to work by repairing damaged neural pathways in the brain, alleviating depressive symptoms. Unlike antidepressants, which attempt to raise serotonin levels, ketamine works on the glutamate system.

Ketamine treatment for bipolar depression typically involves administering the drug intravenously in sub-anesthetic doses. Ketamine can produce rapid improvements in mood, sometimes within hours. This is unlike conventional antidepressants, which often take weeks to show positive results, This rapid onset with ketamine is particularly beneficial for bipolar patients experiencing severe depressive episodes who may be at risk of suicide.

With serial administrations of intravenous ketamine, rapid anti depressive and antisuicidal effects have been noted without any significant side effects.  Recent studies have demonstrated that IV ketamine has a significant impact when it comes to reducing agitation, irritability and anxiety, as well.

Creating Space for Long-Lasting Change

While ketamine can be useful in cases of acute depression, the objective of treatment is always long-term, long-lasting change. The most effective treatment plans include a series of ketamine treatments in conjunction with ongoing therapy. Ketamine promotes neuroplasticity.  This allows the brain to alter its structure, make connections and repair synapses.

During treatment is the best time to engage in therapy while the brain is particularly receptive to making connections and learning new skills. For this reason, treatment plans for patients in our clinic include working with a therapist in conjunction with ketamine infusions. The combination is a potent one.  Ketamine’s antidepressive and neuroplasticity effects create the space for effective therapy to bring relief to those suffering from Bipolar I & II.

What is different about treating Bipolar Depression?

Treating bipolar depression is not that different from treating other depression diagnoses. However, the primary goal in treating bipolar depression is to help manage the ups and downs of the disorder. By stabilizing the depressive symptoms, a patient and their providers can work on managing the medications and therapy necessary to fully treat the disorder.

Individual treatment plans will differ depending upon which type of bipolar disorder the patient is experiencing and other unique details about their health history and medications.  For example, when treating Bipolar I, greater care must be taken to avoid triggering a manic episode.  This could take the form of having “guard rails” such as discussions up front about the treatment plan, treating at a slower pace, coordinating care with mental health providers and/or family members, and preparation around warning signs in place prior to treatment.  Treating Bipolar I may require more caution, monitoring, thoughtfulness, communication.

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