Ketamine Treatment for Mood Disorders

Ketamine is a glutamate modulator that increases synaptogenesis at sub-anesthetic doses in animal models. Studies examining ketamine's use in major depressive disorder have yielded large effect sizes for depression symptom reduction, depression remittance, and an independent reduction of suicidal ideation. Although there is more evidence supporting ketamine for the treatment of unipolar depression, studies examining ketamine's use in bipolar depression have also been positive, with no evidence that ketamine induces a "switch" from depression to mania. Although ketamine is sometimes used in conjunction with electroconvulsive therapy (ECT), outstanding evidence indicates little to no enhancement of ECT outcome. A standard dose of intravenous ketamine for depression is 0.5 mg/kg over 40 minutes; current lines of investigation are probing optimal dose and maintenance regimens.