Ketamine May Alleviate Bipolar Depression, Too

Ketamine May Alleviate Bipolar Depression, Too

Some months back, I wrote a blog post about researchers using the ketamine as a fast acting treatment for depression. Recently I was alerted to another study by the same core researchers from the National Institute of Mental Health (NIMH) using ketamine to treatment depression in people with bipolar disorder (Zarate et al., 2012). The study was a replication of a similar study published a few years ago (Diazgranados  et al., 2010).

It’s still just ketamine for depression

In this study, ketamine wasn’t used to treat bipolar disorder as a whole. Rather, ketamine was used to treat depressive symptoms in people with bipolar disorder who were currently depressed. The people in the study were also maintained on mood stabilizers to help manage bipolar mania and hypomania.

Otherwise, the procedure and findings were similar to the other studies. People were randomly assigned to receive two infusions of either ketamine or a placebo (saline). The infusions took about 40 minutes, and the second infusion took place 2 weeks after the first.

Most people who received ketamine (79%) felt less depressed, but no one who received the placebo showed improvements. I should note, though, that it was probably pretty obvious to people who received the placebo that it was not ketamine, as ketamine is a powerful psychoactive with obvious psychological effects. In contrast, saline isn’t likely to cause a detectable physiological response.

The treatment is still very experimental

After my earlier post was published, I received calls from a few people looking for ketamine treatment in Oregon. I’m afraid ketamine is still very much an experimental treatment, and no one, to my knowledge, is using it outside of well-controlled research studies. The only studies I’ve come across were conducted by NIMH researchers in Bethesda, Maryland.

The caveats I discussed in my previous post about the feasibility of ketamine for treating depression remain the same. At this point, we’re still not sure what the long-term effects are of using ketamine for depression. Given that it’s so fast-acting and is already a club drug, there is some potential for abuse and addiction.

Ketamine might be a useful intervention for people who are acutely depressed and acutely suicidal. In this respect, I remain cautiously optimistic, as it could reduce costly inpatient stays.

I’m skeptical, though, that ketamine will prove to be a cure-all wonder drug. For example, a newer study found that people treated with ketamine relapse into depression in an average of 2 weeks (Ibrahim et al., 2012). Although ketamine is safely used as an anesthetic in surgical procedures, we don’t know the impact of frequent doses across an extended period of time.

The newer research I cite in this post doesn’t take any steps towards answering questions about ketamine’s effectiveness beyond a few weeks, but it does suggest that people with bipolar disorder who are in a state of deep depression might find quick, if not enduring, relief from depression.

UPCOMING TRAINING EVENTS

January 31, 2020, 8:30 am – 4:30 pm · Portland, OR · Details

This workshop is intended to be part 1 of a two day workshop, but can also be taken on its own. This workshop is useful for therapists who want an update on the current clinically applicable research on how shame functions, including an overview of how and when shame tends to be adaptive versus maladaptive. This day has two primary goals: 1. To provide an overview of research on shame and self-criticism that can guide clinical practice and 2. To allow therapists to experience the model from the inside-out so as to develop greater personal self-compassion and a deeper intuitive understanding of compassion-based intervention strategies. Read more

February 1, 2020, 8:30 am – 4:30 pm · Portland, OR · Details

This workshop is intended to be part 2 of a two day workshop, but can also be taken on its own. If you already have a thorough understanding of the functions of shame and a good understanding of Acceptance and Commitment Therapy, then it is you will probably be OK taking just the second day of this workshop. The workshop proceeds to discuss how ACT processes can be focused on addressing chronic and pervasive shame-based difficulties, with a particular focus on flexible perspective taking. Demonstrations of how to use perspective taking and compassion-fostering strategies with clients will be provided and attendees will also practice in small groups. An overview of chair work in the context of ACT will be provided. Read more

February 29, 2020, 9:00 am – 12:15 pm · Portland, OR · Details

Exposure is one of most the effective treatments for anxiety, trauma, and obsessive compulsive and related disorders (e.g., OCD, PTSD, panic disorder). A transdiagnostic intervention, exposure involves the repeated and systematic engagement with avoided stimuli that cause anxiety. Unfortunately, exposure remains underutilized by clinicians (e.g., Scherr, Herbert, & Forman, 2015), mostly due to misunderstandings of how exposure works and perceived difficulty of using it with clients. This half-day workshop will address these gaps by drawing from research on enhancing clinician understanding of and ways to overcome barriers to delivering exposure therapy (Farrell et al., 2016). Using didactics, role-play, and experiential exercises, participants will learn flexible application of exposure for a variety of clinical targets. Read more

April 17 and 18, 2020, 9:15 am – 5:00 pm · Portland, OR · Details

Do you ever “get stuck” as a therapist? Do some of your clients press your “hot buttons”? Do you ever find yourself struggling and thinking about “what do I do next” or feeling anxious, scared or stressed in therapy? In this workshop we will work on clarifying your therapist values and defining what is “difficult” about “difficult” clients. Through discussions, demonstrations and roleplays we will then work on these difficult clients and look at the processes from a compassionate ACT perspective. Read more