Affective Switch Associated With Oral, Low Dose Ketamine Treatment in a Patient With Treatment Resistant Bipolar I Depression. Case Report and Literature Review

Wilkowska, Aleksandra; Szałach, Łukasz P.; Słupski, Jakub; Wielewicka, Aleksandra; Czarnota, Małgorzata; Gałuszko-Węgielnik, Maria; Wiglusz, Mariusz S.; Cubała, Wiesław Jerzy

doi:10.3389/fpsyt.2020.00516

Cited by 7 publications

(3 citation statements)

References 26 publications

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“…Although the risk of an affective switch in available studies seems low, manic symptoms should be monitored in bipolar patients treated with ketamine, especially those treated with antidepressants. 50 In this study, no affective switch was observed, although more studies on larger groups of bipolar patients are needed to confirm this observation.…”

Section: Discussionmentioning

confidence: 49%

Intravenous Ketamine Infusions in Treatment-Resistant Bipolar Depression: An Open-Label Naturalistic Observational Study

Wilkowska¹,

Włodarczyk²,

Gałuszko-Węgielnik³

et al. 2021

NDT

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Purpose Bipolar disorder is a chronic and recurrent condition often associated with treatment resistance and suicidality. There is an unmet need for effective treatment in this group of patients. Ketamine has been demonstrated to have antidepressant and antisuicidal properties in unipolar depression. Most of the available studies concern unipolar depression. Here, we present the efficacy and safety of IV ketamine as an add-on treatment in patients with bipolar I and bipolar II depression. Patients and Methods Thirteen patients with treatment-resistant bipolar depression (TRBD) received eight IV infusions of 0.5 mg/kg ketamine twice a week over four weeks. This is an open-label naturalistic observational study. Ketamine is an add-on treatment. Depressive symptoms were measured with the Montgomery–Asberg Depression Rating Scale (MADRS), and manic symptoms were measured with the Young Mania Rating Scale (YMRS). Psychomimetic symptoms were assessed with the Clinician-Administered Dissociative States Scale (CADSS) and the Brief Psychiatric Rating Scale (BPRS). Results The rates of response and remission after the seventh infusion of ketamine were 61.5% and 46.2%, respectively. A significant antisuicidal effect was observed in responders at the 7th infusion. Suicidality was measured with item 10 on the MADRS scale. The average time to respond was between 21.1 and 23.2 days to remission. There was an increase in the CADSS scores during the treatment compared to baseline and follow-up, but no differences between responders and non-responders were observed. No affective switch was observed according to the YMRS scale scores. Ketamine treatment was associated with a transient increase in arterial blood pressure. No serious adverse events, however, were observed. Conclusion This report presents the preliminary results of IV ketamine effectiveness and safety in treatment-resistant bipolar depression. The findings suggest that it is a feasible, safe and well-tolerated treatment option in this group of patients. There is a definite need for more studies in this field.

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Section: Discussionmentioning

confidence: 49%

Intravenous Ketamine Infusions in Treatment-Resistant Bipolar Depression: An Open-Label Naturalistic Observational Study

Wilkowska¹,

Włodarczyk²,

Gałuszko-Węgielnik³

et al. 2021

NDT

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“…Figure 3 and Table 4 demonstrate no significant changes in YMRS scores during ketamine therapy, suggesting that none of our patients exhibited an affective switch. Data on affective switch during ketamine therapy in the literature are limited and inconsistent, necessitating further investigation ( Niciu et al, 2013 ; Allen et al, 2019 ; Wilkowska et al, 2020 ). We observed a decrease in dissociative symptoms in both groups ( Figures 4 , 5 and Tables 5 , 6 ), as measured by CADSS before and 30 min after infusion.…”

Section: Resultsmentioning

confidence: 99%

Central nervous system-related safety and tolerability of add-on ketamine to standard of care treatment in treatment-resistant psychotic depression in patients with major depressive disorder and bipolar disorder

et al. 2023

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BackgroundPsychotic treatment-resistant depression represents a complex and challenging form of mood disorder in clinical practice. Despite its severity, psychotic depression is frequently underdiagnosed and inadequately treated. Ketamine has demonstrated rapid and potent antidepressant effects in clinical studies, while exhibiting a favorable safety and tolerability profile. Although there is limited literature available on the use of ketamine in psychotic TRD, reports on its efficacy, safety, and tolerability profile are of great interest to clinicians. The aim of this study is to investigate the relationship between dissociative symptomatology and psychomimetic effects in inpatients with treatment-resistant major psychotic depression and treatment-resistant bipolar psychotic depression, who receive intravenous ketamine treatment alongside psychotropic medication, both during and after treatment.Materials and methodsA total of 36 patients diagnosed with treatment-resistant unipolar (17 patients) or bipolar (18 patients) depression with psychotic features were treated with eight intravenous infusions of 0.5 mg/kg ketamine twice a week over 4 weeks. Ketamine was given in addition to their standard of care treatment. The severity of depressive symptoms was evaluated using the MADRS, while dissociative and psychomimetic symptoms were assessed using the CADSS and BPRS, respectively.ResultsThere were no statistically significant changes observed in MADRS, CADSS, and BPRS scores within the study group during ketamine infusions. However, significant improvements in MADRS, CADSS, and BPRS scores were observed during ketamine infusions in both the unipolar and bipolar depression groups.ConclusionThis study provides support for the lack of exacerbation of psychotic symptoms in both unipolar and bipolar depression.

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“…One risk associated with the antidepressant use of psychotomimetic drugs, sleep deprivation, fasting or ketogenic diet is the possibility of triggering a switch towards mania and psychosis. 204 , 205 , 206 There are plenty of examples, however, when compensatory switches—even ones that resemble mania or psychosis—do not lead to progressive dysregulation and dysfunction. The transition from initial shamanic sickness to shamanic death‐rebirth experience and shamanic election 207 is one example, as are innumerable other types of salvific, spiritual or secular self‐transformative experiences.…”

Section: Classic Psychedelic Compensation: 5‐ht2ar Activationmentioning

confidence: 99%

Psychotomimetic compensation versus sensitization

Brouwer,

Carhart‐Harris,

Raison

2024

Pharmacology Res & Perspec

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It is a paradox that psychotomimetic drugs can relieve symptoms that increase risk of and cooccur with psychosis, such as attention and motivational deficits (e.g., amphetamines), pain (e.g., cannabis) and symptoms of depression (e.g., psychedelics, dissociatives). We introduce the ideas of psychotomimetic compensation and psychotomimetic sensitization to explain this paradox. Psychotomimetic compensation refers to a short‐term stressor or drug‐induced compensation against stress that is facilitated by engagement of neurotransmitter/modulator systems (endocannabinoid, serotonergic, glutamatergic and dopaminergic) that mediate the effects of common psychotomimetic drugs. Psychotomimetic sensitization occurs after repeated exposure to stress and/or drugs and is evidenced by the gradual intensification and increase of psychotic‐like experiences over time. Theoretical and practical implications of this model are discussed.

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Affective Switch Associated With Oral, Low Dose Ketamine Treatment in a Patient With Treatment Resistant Bipolar I Depression. Case Report and Literature Review

Cited by 7 publications

References 26 publications

Intravenous Ketamine Infusions in Treatment-Resistant Bipolar Depression: An Open-Label Naturalistic Observational Study

Intravenous Ketamine Infusions in Treatment-Resistant Bipolar Depression: An Open-Label Naturalistic Observational Study

Central nervous system-related safety and tolerability of add-on ketamine to standard of care treatment in treatment-resistant psychotic depression in patients with major depressive disorder and bipolar disorder

Psychotomimetic compensation versus sensitization

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