Ketamine and Bipolar Disorder: What the Research Actually Says
Bipolar disorder is a mental health condition marked by dramatic shifts in mood, energy, and activity levels. Seen as one of the most complex and misunderstood of conditions, the path to stability for those living with bipolar disorder often involves a combination of medications, therapy, and lifestyle changes.
Ketamine for bipolar disorder has emerged as part of that therapy conversation.
In recent years, ketamine therapy—with its rapid-acting effects on treatment-resistant depression—has garnered attention as a new form of hope for people suffering from bipolar disorder, especially if traditional therapies fall short.
So what does research have to say about ketamine and bipolar disorder? We’ll dive into where the science stands today, getting to the core of ketamine’s benefits and where to exercise caution.
Understanding Bipolar Depression
Understanding the potential of ketamine in treating bipolar disorder starts with a clear picture of what bipolar depression is and how it differs from other depressions.
With bipolar disorder, there are episodes of depression and mania. The pattern and severity of the episodes depends on the type of bipolar disorder we’re talking about:
- Bipolar I disorder: Full manic episodes (sometimes requiring hospitalization) that often alternate with episodes of major depression
- Bipolar II disorder: Less extreme highs but depressive episodes that can be just as intense as in Bipolar 1 disorder and are sometimes even more frequent
One of the biggest hurdles in bipolar depression treatment is finding treatments that don’t cause further damage. The antidepressants used to treat common forms of depression can cause a person to switch over into mania or rapidly cycle between moods.
Between these concerns and the fact that treatments can offer limited benefits and take weeks to show results in other cases, alternative treatments are gaining ground. As research shows, ketamine lives up to its promise as an effective form of treatment for bipolar depression.
What Research Says About Ketamine for Bipolar Disorder
Ketamine therapy is known for its rapid effects, and research has shown that this same sentiment applies to bipolar depression treatment.
A recent systematic review analyzed the effectiveness of ketamine in treating bipolar depression, a condition where standard treatments often fall short. The review included 6 clinical studies with a total of 135 participants (53% female, average age ~45). All studies used 0.5 mg/kg of intravenous ketamine, administered as an add-on to existing mood stabilizers.
The results were striking: 61% of patients receiving ketamine experienced a 50% or greater reduction in depression symptoms, compared to just 5% in the placebo group. Individual study response rates ranged from 52% to 80%. While ketamine was generally well tolerated, there were a few adverse effects: Two participants (one from each group) developed manic symptoms, and some patients experienced dissociative effects shortly after infusion.
In another study, 66 patients with treatment-resistant bipolar depression received four IV ketamine doses over the course of two weeks. Based on measurements from the Quick Inventory for Depression Symptomatology Self-Report-16 (QIDS-SR16), there were notable reductions in anxiety and suicidal thoughts, alongside functional improvements. No cases of psychosis or mania were reported.
Another recent study looked at how well IV ketamine works for people with tough-to-treat depression or bipolar disorder, especially when they also deal with things like anxiety, irritability, agitation, and thoughts of suicide.
The study followed 201 adults who received repeated ketamine treatments at a community clinic. Out of those, 113 people had strong symptoms of anxiety, irritability, and agitation—what doctors sometimes call “mixed features,” which are common in bipolar depression.
The results were encouraging. People with those extra symptoms (AIA) showed more improvement in their overall depression, anxiety, irritability, and agitation than those without. For example:
- Anxiety went down significantly
- Irritability dropped by a wide margin
- People reported feeling more relaxed
- Suicidal thoughts also decreased
The researchers concluded that IV ketamine may be especially helpful for people with mood disorders who have these intense, secondary symptoms—not just depression, but also the agitation and anxiety that often come with it. It could offer faster, more complete relief than traditional treatments.
Clinical Cautions & Real-World Use
In the treatment of bipolar patients, ketamine therapy requires strict medical supervision. Clinicians need to evaluate a patient’s history of manic episodes, their current state, and any adverse reactions they’ve had to medications in the past before treatment. If there’s a recent history of mania, ketamine may be a less appropriate option as it can trigger mania in some cases. Alternatively, it could mean implementing more safeguards to reduce the risk of destabilization.
Safe treatment also calls for mood tracking and ongoing monitoring. After a ketamine session, clinicians should observe patients for early signs of mood elevation, agitation, impulsivity, or sleep disturbances—all of which can signal the onset of mania. While this can help prevent a full-blown manic episode, it can also prompt the need for adjustments to a patient’s treatment plan, such as spacing out doses.
The effectiveness and safety of ketamine for bipolar disorder is built on collaborative care too. Ketamine providers should work closely with a patient’s psychiatric team to support continuity of care and avoid destabilizing outcomes. Structured assessment tools, for instance, can help assess progress, including any side effects or subtle shifts that could indicate early signs of mania. With providers aligned and sharing information in real-time, they can further fine-tune a patient’s treatment program.
Realistic Expectations & Next Steps
Ketamine is not meant to be a cure for bipolar disorder. It does not replace mood stabilizers, therapy, or lifestyle strategies that support long-term stability, but rather provides a source of meaningful relief alongside them. This is particularly true in the case of those struggling with treatment-resistant bipolar depression.
If you’re considering ketamine for bipolar disorder, the first step is open and honest communication with your providers. Share your full psychiatric history (including any past manic episodes or hospitalizations) with your care team. That way, they have the context to assess if ketamine is a good option for you and how to safely proceed.
It’s also important to seek treatment through licensed, experienced clinics that understand the unique needs of individuals with bipolar disorder. Ask them how they screen patients, monitor progress, and coordinate with other members of your care team.
The last point we’ll make: ketamine should be embedded within a whole-person approach to care. There should be an emphasis around ketamine’s potential risks and benefits, access to mental health support, and a plan that is designed to help build a sustainable path forward, versus just relieving symptoms in the short term.
Considering ketamine therapy for yourself or a loved one? New Pathways offers ketamine treatment for bipolar disorder throughout the state of Ohio. We provide personalized treatment for every patient who walks through our doors, always acting in their best interest. It all starts with a free consultation.