Bipolar disorder (BD) is a psychiatric illness associated with high morbidity, mortality and suicidal rate. It has neuroprogressive course and a high rate of treatment resistance. Bipolar disorder is a burdensome and recurrent psychiatric condition that affects more than 1% of the population, and has the highest risk of suicide among all psychiatric disorders. Research has shown that most patients experience depression for a significant part their lives.
The treatment failure rates of bipolar depression are higher than those of major depression disorder (MDD). A longer duration of bipolar disorder leads to neuroprogression which involves structural brain changes and neuropsychological deficits. Currently, there is an unmet options for both short- and long-term treatment options for patients with refractory bipolar depression.
TREATMENT RESISTANT BIPOLAR DISORDER (TRBD).
TRBD is the health condition in which there is a lack of response to treatment to at least two previously established treatments for bipolar depression. Despite the importance of TRBD, only a small number of recognized treatment options are available. A few trials have indicated a role for electroconvulsive therapy and repetitive transcranial magnetic stimulation.
While recent network meta-analysis have shown consistent evidence for use of multiple pharmacotherapies in non-TRBD, there is more limited evidence for use of medication based treatments in TRBD.
TREATMENT OF BD WITH KETAMINE.
Ketamine appears to have rapid anti-depressive and anti-suicidal effects. The robust anti-depressant and anti-suicidal effects of ketamine in treatment-resistant patients, as well as its unique mechanism of action, may point o ketamine as an interesting treatment option for BD. Research has reported a rapid and consistent effects of ketamine on BD patients, which included the improvement of mood level and stability, cognition and sleep. A recent study suggests that using ketamine to treat resistant depression has a rapid effect in reducing agitation, irritation and anxiety and suicidal ideation.