Efectividad de la ketamina en depresión bipolar: revisión sistemática de la literatura

Abstract

Introduction: Although most distinctive clinical feature of bipolar disorder is pathologically elevated mood, this is often not the prevailing mood of the disease. The depressive phase of bipolar disorder or bipolar depression is more chronic, leads to further deterioration and represents an usual therapeutic challenge. At present, the pharmacological management of bipolar depression usually involves combinations of at least two different drugs, including mood stabilizers (lithium and anticonvulsants), atypical antipsychotics and antidepressants. The aim of this study is to evaluate the efficacy of ketamine in bipolar depression. Methods: Systematic review of papers that provide information about efficacy of ketamine in depressive phase of bipolar disorder. Results: Of the 147 preselected papers, two satisfied the selection criteria (n=33). Compared with placebo, ketamine has a rapid long-lasting antidepressant effect, even in patients who have received more than 3 medications previously. No severe adverse effects were reported. Discussion. Current evidence suggests that ketamine a) is useful in the treatment of bipolar depression, even if it is treatment-resistant, b) is safe and c) may have some antisuicidal effect. It is needed to extend the available evidence