Special K for Bipolar Depression

[Manicsleep]

http://www.nytimes.com/2010/08/10/health/10depress.html

http://archpsyc.ama-assn.org/cgi/content/full/67/8/793

The top is the Times article and the bottom is the actual article.
Interesting response for both depression and anxiety symptoms.

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[Molls]

How about MDMA for couples therapy.

 

[OldPsychDoc]

How about MDMA for couples therapy.

Merlot is cheaper and more readily available.

 

[Doc Samson]

Merlot is cheaper and more readily available.

Depends on your neighborhood.

 

[sonofthesouth]

hmmm, interesting... thanks for the post, manicsleep!

 

[jettavr6]

http://www.nytimes.com/2010/08/10/health/10depress.html

http://archpsyc.ama-assn.org/cgi/content/full/67/8/793

The top is the Times article and the bottom is the actual article.
Interesting response for both depression and anxiety symptoms.

Interesting article. We give ketamine to patients for the treatment of complex regional pain syndrome. Many of our patients have comorbid psychiatric conditions including bipolar disorder. One thing I can say is that I haven't seen a patient become more depressed from Ketamine. We give very low doses. I'd be interested in researching it more.

 

[Manicsleep]

Interesting article. We give ketamine to patients for the treatment of complex regional pain syndrome. Many of our patients have comorbid psychiatric conditions including bipolar disorder. One thing I can say is that I haven't seen a patient become more depressed from Ketamine. We give very low doses. I'd be interested in researching it more.

How often do you give it, by what means and what doses?

I am guessing you haven't actually seen improvement in depression symptoms right? The study indicated significant improvement within a very short period of time that tended to last a couple of days.

 

[billypilgrim37]

One of my co-residents last year had a depressed gentleman who was receiving an extended course of ECT with little response. Because of some difficulties surrounding the anesthesia, a decision was made to actually use ketamine as part of his sedation. On the day of this treatment, after receiving anesthesia, he became excessively tachycardic and hypertensive. After he was stabilized medically, that session of ECT (I think around his 15th?) was cancelled for the day. By the time he woke up later that day, his affect was significantly brightened, his symptoms were 90% improved, and he was discharged within the week. He had demonstrated very little response prior to medications or ECT, and I think he had been in the hospital for going on about four months at that point.

Obviously, there are other possible explanations for the brightening, but the dramatic response was pretty hard to knock.

 

[Encephalopathy]

There is a lot of evidence for ketamine in treatment refractory MDD as well. Check out Zarate's NIMH study, I think the dosage was 0.5 mg/kg IV (sorry I'm not at home to provide link). IMO pretty impressive evidence for rapid results (hours).

It's quite frustrating not being able to use it because of medicolegal concerns, but I guess it's my fault for never actually learning to intubate. Nevertheless, no reports of respiratory depression using such a relatively low dose.

I think NMDA antagonism is the future, we just need something PO and stronger than memantine. Although there are case studies in nursing homes showing PO ketamine was helpful (although there is a significant first pass effect).

 

[jettavr6]

How often do you give it, by what means and what doses?

I am guessing you haven't actually seen improvement in depression symptoms right? The study indicated significant improvement within a very short period of time that tended to last a couple of days.

25mg once a day, with results for neuropathic pain seen very quickly. Improvement in depression is quite possible since pain is often the cause of their depression.

 

[Encephalopathy]

Here is the trial I referenced: http://www.ncbi.nlm.nih.gov/entrez/...ve&db=PubMed&dopt=Citation&list_uids=16894061

Here is one that showed ketamine + ect > propofol + ECT: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=19935085

Jetta - May I ask what your specialty is? Are you using PO or IV?

 

[RedPakotaSea]

Zarate also published a follow-up paper with a hypothesized mechanism.

Maeng S, Zarate CA Jr. The role of glutamate in mood disorders: results from the ketamine in major depression study and the presumed cellular mechanism underlying its antidepressant effects. Curr Psychiatry Rep. 2007 Dec;9(6):467-74.

"In this article, we first review a study showing that the N-methyl-d-aspartate (NMDA) receptor antagonist ketamine leads to rapid, robust, and relatively sustained antidepressant effects in patients with treatment-resistant major depression. We then discuss our hypothesis that the therapeutic effects of monoaminergic antidepressants and ketamine may be mediated by increased AMPA-to-NMDA glutamate receptor throughput in critical neuronal circuits. We hypothesize that ketamine directly mediates this throughput, whereas monoaminergic antidepressants work indirectly and gradually; this may explain, in part, the lag of onset of several weeks to months that is observed with traditional antidepressants."

PMID: 18221626 [PubMed - indexed for MEDLINE]

 

[Manicsleep]

I am familiar with the glutamate hypothesis however this has been posited for other illnesses as well, particularly schizophrenia. Other studies indicate elevation in mood and a dissociative state.

The reason I was asking Jetta was because I assumed it was an oral administration and also I wanted to know if he had seen any switches over to mania.

I am curious what would happen in the bipolar depression folks over time. Do they have a tendency to switch over to mania and at what rate. From my own perspective I am curious to see someone do some continuous PSG monitoring for 72 hours post infusion.