The effectiveness of ketamine on anxiety, irritability, and agitation: Implications for treating mixed features in adults with major depressive or bipolar disorder

Roger S McIntyre, Orly Lipsitz, Nelson B Rodrigues, Yena Lee, Danielle S Cha, Maj Vinberg, Kangguang Lin, Gin S Malhi, Mehala Subramaniapillai, Kevin Kratiuk, Andrea Fagiolini, Hartej Gill, Flora Nasri, Rodrigo B Mansur, Trisha Suppes, Roger Ho, Joshua D Rosenblat

39 Citations (Scopus)

Abstract

OBJECTIVE: To determine the effectiveness of intravenous (IV) ketamine on anxiety, irritability, agitation, and suicidality, in adults with treatment-resistant major depressive disorder (MDD) or bipolar disorder (BD).

METHOD: Adults (N = 201) with treatment-resistant MDD or BD received repeat-dose IV ketamine treatment at a community-based clinic. Mixed features were measured using symptoms of anxiety, irritability, and agitation (AIA), as measured by the Generalized Anxiety Disorder-7 (GAD-7) scale. The Quick Inventory for Depressive Symptomatology Self-Report-16 (QIDS-SR16 ) was used to measure overall treatment response, and the QIDS-SR16 suicidal ideation (SI) item was used to measure change in SI symptoms with ketamine treatment. The anxiety, irritability, and agitation items on the GAD-7 were used to assess effectiveness of IV ketamine in treating symptoms of mixed features.

RESULTS: In this retrospective analysis, 113 participants met AIA criteria. Participants with AIA experienced a significantly greater reduction in overall depressive symptoms (F(1, 558) = 9.49, P = .002), SI (F(1, 558) = 3.103, P = .079), anxiety (F(1, 198) = 5.52, P = .007), irritability (F(1, 198) = 28.35, P < .001), and agitation as measured by "trouble relaxing" (F(1, 198) = 6.70, P = .010) from baseline compared to the non-AIA group, regardless of number of treatments received.

CONCLUSIONS: Our preliminary results suggest that IV ketamine is effective in rapidly treating AIA and SI in adults with treatment-resistant mood disorders. This observation suggests that IV ketamine could be considered a treatment alternative for adults with MDD or BD presenting with mixed features.

Original languageEnglish
JournalBipolar Disorders
Volume22
Issue number8
Pages (from-to)831-840
Number of pages10
ISSN1398-5647
DOIs
Publication statusPublished - 13 May 2020

Keywords

  • bipolar depression
  • intravenous ketamine
  • NMDA
  • suicidal ideation
  • treatment-resistant depression

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