Ketamine therapy for bipolar depression

What the evidence says

Two placebo-controlled trials found a single ketamine infusion added to lithium or valproate rapidly reduced bipolar depression symptoms, with response in about half of patients and effects lasting several days. Repeated infusion series have been studied less, but clinical series report response rates similar to unipolar depression. See the coverage hub, the ketamine therapy hub, and the coverage checker.

Safety in bipolar disorder

Treatment is given with a mood stabilizer continued throughout, and clinics screen for manic symptoms at each visit. Rates of treatment-emergent mania in the trials were low. Ketamine is not used during a mixed or manic episode.

Who is a candidate

Adults with bipolar I or II depression that has not responded to standard treatment (quetiapine, lurasidone, lamotrigine, lithium), stable on a mood stabilizer, without contraindications to ketamine.

Coverage and cost

Not covered by insurance. Cash prices run $350 to $850 per infusion. Because Spravato excludes bipolar disorder, ketamine infusions and ECT are the practical interventional options. See ketamine clinics by state.