Abstract
The current psychopharmacological treatment approaches for major depression focus on monoaminergic interventions, which are ineffective in a large proportion of patients. Globally, treatment-resistant bipolar depression (TRBD) affects up to 33% of depressive patients receiving treatment. Certain needs are still unmet and require new approaches. Many studies are in favor of treatments with ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist, even in single use, whose effects emerge in minutes to hours post administration. However, little data are available on ketamine performance in TRBD patients with somatic comorbidities, including highly prevalent ones, i.e., cardiovascular disease (heart failure, hypertension, post-myocardial infarct, arrhythmias, etc.) diabetes, and obesity, and depression-associated comorbidities such as stroke, epilepsy, as well as in the elderly population. The literature shows that treatment with ketamine is efficacious and safe, and the majority of adverse drug reactions are mild and tend to mostly disappear within 30 min to 2 h of ketamine administration.
Highlights
Bipolar disorder is considered a major health problem worldwide because of the increased rates of premature mortality and disability [1]
Recent ketamine and esketamine research has resulted in promising outcomes in Treatment-resistant bipolar depression (TRBD) treatment [3,6]
Evidence suggests that short- or long-term use of esketamine nasal spray is highly unlikely to be associated with withdrawal syndrome, as shown by the scores regarding stability, frequency, onset, and severity assessed by PWC-20 [23,24]
Summary
Bipolar disorder is considered a major health problem worldwide because of the increased rates of premature mortality and disability [1]. An N-methyl-D-aspartate (NMDA) receptor antagonist, is known since 1963 when it was introduced in anesthesia and is characterized by safety and rapid action [7] It has recently been investigated as an antidepressant in treatment-resistant depression (TRD) patients and received. In a study of 14 TRD patients given low ketamine doses in the sublingual form (10 mg s.l.), no efficacy for the treatment of TRBD was seen, and adverse drug reactions were observed [15]. There is other evidence showing that the effects of oral ketamine are not as rapid as those associated with intravenous administration [20] These results are promising, there are still no data regarding the effective dose, as the current dosing varies from 2.0 up to 2.5 mg/kg of body mass weight. More studies examining the effects of different doses are needed
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