Being a Boy or Girl Around the World

Bipolar Disorder: Ketamine Treatment

BIRDMAN

“Mike Shiner: A man becomes a critic when he cannot be an artist, the same way that a man becomes an informer when he cannot be a soldier.”

INTRODUCTION:

Depression takes on many forms. Unlike unipolar depression, current antidepressant treatments and medication for bipolar depression [part of a larger condition known as bipolar disorder] are less effective and fail to properly treat depressive episodes patients with bipolar disorder experience. Roughly 1/4^th of individuals who are diagnosed with bipolar disorder have attempted at least one suicide attempt within their lifetime. Bipolar disorder is a chronic illness that affects the brain chemistry, causing extreme mood swings that vary in periods of time. 

Symptoms differ depending on the type of episode [Manic Episodes, “the Highs” or Depressive Episodes, “the Lows”]. During manic episodes [“the Highs”] individual has feelings of euphoria, abnormal excitement, or elevated mood. Excessive talking, sleeping less than normal amount, energetic and even feelings of agitation. They also tend to engage in risky behavior [i.e. lavish spending, impulsive sexual encounters, or ill-advised business decisions]. Decreased interest in activities once enjoyed, loss of energy, difficultly sleeping [too much or very little], changes in appetite, thoughts of death or suicide, and difficulty concentrating, remembering, or making decisions is known as a depressive episode [“the Lows”]. [D]

Bipolar disorder [or Manic Depression] affects 12.3 million people in the US alone and 60 million people worldwide. Half of all patients begin seeing symptoms between the ages of 15 and 25, but it can begin at any age. People with bipolar disorder often also have other mental health disorders. Some people may experience mood swings that are less extreme than a full manic episode, known as hypomania. Although there is no cure for bipolar disorder, it’s symptoms can be controlled with a combination of varied combination of approaches. Effective treatment plans include medication, talk therapy/counseling, better knowledge of the condition, and self-care strategies. [D]

The study- published in Bipolar Disorders Journal- discovered that Ketamine- an anesthetic drug- rapidly relieves the symptoms of depression. Thoughts of suicide in patients with bipolar disorder declined significantly within 24 hours following treatment with ketamine. With Ketamine available and continuing research could possibly help these individuals with bouts of suicide. Although it’s side effects include hallucinations, dissociation (a feeling of being outside of one’s body), and is potentially addictive; researchers are using Ketamine as a stepping stone for clues that could lead to better treatments.[D]

BACKGROUND INFORMATION:

In the last decade, ketamine, in low doses, has been used to help people suffering from major depression, bipolar depression, postpartum depression, generalized anxiety, OCD, PTSD and even acutely suicidal thoughts in a matter of hours as opposed to months. Ketamine is used to treat Major Depressive Disorder and to alleviate depressive symptoms caused by bipolar depression. Ketamine is a medication that was originally developed in the 1960s as a general anesthetic. A medication with anti-suicidal properties is ketamine (given intravenously). [C]

Before Ketamine was discovered in the 1960s, there was Lithium [medication that has been found to be useful in dissolving uric acid crystals and later used to treat bipolar disorder- mania and depression- since the 1800s]. It was in 1949 when a study lead by John Cade, an Australian psychiatrist, published his results in treating guinea pigs with lithium calmed the animals down. These findings led to the FDA approving Lithium for the acute treatment of bipolar disorder (mania) in 1970 and maintenance therapy. [C]

Lithium is often used by psychiatrists for their patients because of its antidepressant properties which help their antidepressant medications work more effectively. Lithium is the only one of two oral medications on the market available today that have anti-suicidal properties. Patients taking Lithium should be monitored carefully for normal thyroid and kidney function because this medication has been known to affect these organs. Lithium and ketamine can be taken at the same time. There is also some overlap in cell signaling pathways between lithium and ketamine and due to this reason, there have been some theories that this combination may increase the effectiveness of response to ketamine. [C]

RESEARCH:

Ketamine has been found to reduce depression in patients with bipolar disorder, but what about cases where bipolar patients are clinically diagnosed with severe suicidal thoughts? Michael F. Grunebaum, M.D., from Columbia University Medical Center and his team tackled this feat.

The team of researchers had 16 patients with bipolar disorder to participate in the study. Every participant that was chosen reported experiencing a major depressive episode and significant suicidal thoughts at the time of the trial. Each was randomly assigned to receive a single dose of either ketamine or midazolam, a sedative that has not been found to alleviate symptoms of depression.

Within 24 hours after treatment, thoughts of suicide dramatically decreased in participants who received ketamine than those who received midazolam. The decline in suicidal thoughts, improved their memory in the process. More research is needed with favorably a larger clinical trial to be tested to further evaluate ketamine’s effects on suicidal thoughts associated with bipolar disorder. [A]

 

 

Another study lead by Joshua Kantrowitz, MD, an assistant professor of psychiatry at Columbia University, to conduct a small study of 8 patients diagnosed with bipolar depression. Although ketamine's antidepressant effects are fast acting they last only for a short period of time. So by adding two already existing medications along with ketamine could extend ketamine's effects, reducing symptoms of depression and suicidal thoughts in patients. [B]

Each patient was randomly given one of commonly prescribed medications known to treat bipolar depression. Out of the 8 participants, 4 were given the drug Latuda [a medication approved for bipolar depression], 2 were given a combination of Zyprexa and Prozac, and the last 2 were only given Seroquel. [B]

After 4 weeks, there was no improvement seen in the participants. Then, they were given ketamine. The next day they were given D-cycloserine [medication typically used in the treatment of tuberculosis]. This lasted for eight weeks. Unlike most antidepressants on the market that target the brain’s serotonin pathway, ketamine and D-cycloserine target the brain’s NMDA receptors (NMDAR). [B]

RESULTS:

A small pharmaceutical company, NeuroRx, Inc., is developing a staged treatment approach involving ketamine administration followed by a combination, known as Cyclurad, of D-cycloserine and lurasidone, to maintain the effect of ketamine. Although the Columbia study is the second human study demonstrating the antidepressant effect of D-cycloserine, it is the first one to use the combination of D-cycloserine and lurasidone following ketamine infusion. [B]

Ketamine reduced suicidal thoughts in bipolar disorder within 24 hours in a small randomized trial. People with bipolar disorder who were experiencing significant suicidal thoughts saw those thoughts decline within 24 hours after a single dose of ketamine. [A]

When participants were given a combination of ketamine and D-cycloserine, there was a 50% reduction in signs of depression and a 75% decline in thoughts of suicide. [Results reported in the Journal of Clinical Psychiatry]. It was also observed that D-cycloserine helped to maintain the benefits of the ketamine over the eight-week period of which the study lasted. [B]

CONCLUSION:

Patients with bipolar disorder who feel stable with their lithium medication and overall treatment who continue to experience depressive episodes, ketamine seems like another option to help with these episodes. Although many of the side effects of ketamine are transient and tend to dissipate within a couple of hours after treatment. With its fast acting and lower side effects of sub-anesthetic doses than standard psychiatric treatments, ketamine can be a good alternate option. [C]

For manic patients, lithium in addition to depakote and tegretol are considered the best and standard treatment for bipolar patients. Medications like latuda and seroquel are also used but have higher levels of risks for side effects. Ketamine is certainly not a substitute for lithium in the treatment of mania, but ketamine will usually dramatically improve symptoms in those with bipolar depression by providing a safe, low-risk option with high reward potential. [C]

[*Knowing what form you have is important because there are different treatment options for different types of depression. Be sure to consult a medical professional/ your physician about these options.*]

Links:

https://www.bbrfoundation.org/content/trial-finds-rapid-reduction-suicidal-thoughts-after-ketamine-treatment-patients-bipolar [A]

http://www.psychiatryadvisor.com/mood-disorders/drug-combo-ketamine-treatment-bipolar-depression/article/422760/ [B]

https://ktcpartnership.com/2016/10/bipolar-disorder-lithium-ketamine-need-know/ [C]

http://www.latuda.com/bpd/what-is-bipolar-depression.html [D]

 *Please note! These images are not mine. They were found on various tumblr, pinterest, google image sites! If any are yours please let me know so that I can give you credit for them! Also the people in the images have no relation to the diseases, illnesses, or cancers I write about. Thanks so much & enjoy~
Quotes found on: imdb.com/birdman
Images found on: filmscreencaps.com/ birdman