Cuomo Alessandro, Pardossi Simone, Barillà Giovanni, Carmellini Pietro, Firenzuoli Bernardo, Tarantino Francesca, Tinturini Rebecca, Fagiolini Andrea
Division of Psychiatry, Department of Molecular and Developmental Medicine, University of Siena School of Medicine, Siena 53100, Italy.
Division of Psychiatry, Department of Molecular and Developmental Medicine, University of Siena School of Medicine, Siena 53100, Italy.
J Affect Disord. 2025 May 1;376:76-83. doi: 10.1016/j.jad.2025.01.059. Epub 2025 Feb 2.
Ketamine's use in treating bipolar depression must account for risks, such as switching to manic episodes or worsening symptoms. This study examines ketamine's impact on depressive symptoms, focusing on 'inner tension,' 'sleep reduction,' and 'suicidal ideation' over four weeks in treatment-resistant bipolar disorder (TR-BD) patients. Fifty-nine patients with TR-BD were treated consecutively with ketamine (avg dose 0.8 mg/kg). Results showed significant reductions in MADRS scores without manic switches. Ketamine was well-tolerated despite polypharmacy. Antidepressant treatment of bipolar depression requires great caution because of the risk of switching to manic-mixed episodes and worsening of symptoms such as internal tension, psychomotor agitation, and suicide risk. The aim of this study was to evaluate the efficiency and tolerability of intravenous ketamine in patients with bipolar I or bipolar II disorder and a current treatment-resistant depressive episode (TR-BD), with the aim of examining: 1) the risk of manic switches; 2) the effect on global depressive symptoms as measured by the Montgomery-Åsberg Depression Rating Scale (MADRS); and 3) the specific effects on the MADRS items of internal tension, sleep disturbance, and suicidal ideation over a four-week period. Fiftynine patients with TR-BD (51.4 ± 12.3 years; 30 % female) treated consecutively with intravenous ketamine (mean dose 0.8 mg/kg) were included in this study. No ketamine-treated patient experienced a manic switch during the observation period. A statistically significant decrease (i.e., improvement) in MADRS global score and scores on the Internal Tension, Reduced Sleep, and Suicidal Ideation items was observed from the second week, with no evidence of worsening of the above symptoms. Patient-reported adverse events were generally mild to moderate.
氯胺酮用于治疗双相抑郁症时必须考虑风险，例如转为躁狂发作或症状加重。本研究考察氯胺酮对抑郁症状的影响，重点关注难治性双相情感障碍（TR-BD）患者在四周内“内心紧张”“睡眠减少”和“自杀观念”等情况。59例TR-BD患者连续接受氯胺酮治疗（平均剂量0.8mg/kg）。结果显示蒙哥马利-奥斯伯格抑郁评定量表（MADRS）评分显著降低，且无躁狂发作转换。尽管患者同时服用多种药物，但氯胺酮耐受性良好。由于存在转为躁狂-混合发作以及内心紧张、精神运动性激越和自杀风险等症状加重的风险，双相抑郁症的抗抑郁治疗需要格外谨慎。本研究的目的是评估静脉注射氯胺酮对I型或II型双相情感障碍及当前存在难治性抑郁发作（TR-BD）患者的有效性和耐受性，旨在考察：1）躁狂发作转换的风险；2）用蒙哥马利-奥斯伯格抑郁评定量表（MADRS）衡量的对整体抑郁症状的影响；3）在四周内对MADRS项目中内心紧张、睡眠障碍和自杀观念的具体影响。本研究纳入了59例连续接受静脉注射氯胺酮治疗（平均剂量0.8mg/kg）的TR-BD患者（年龄51.4±12.3岁；30%为女性）。在观察期内，接受氯胺酮治疗的患者均未出现躁狂发作转换。从第二周起，观察到MADRS总分以及内心紧张、睡眠减少和自杀观念项目的评分有统计学意义的下降（即改善），且上述症状无加重迹象。患者报告的不良事件一般为轻至中度。
