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For Patient with Bipolar Disorder, Research Made a Difference

Submitted by ColumbiaPsychiatry on March 30, 2015 at 12:03pm.
Columbia Psychiatry
bipolar disorder research_ketamine

A Participant’s Perspective
Carrie (not her real name) is a bright and articulate 33 year-old upstate New Yorker who knows a good slice of pizza when she tastes it. She looks younger than her age, despite having abused alcohol, cocaine and various drugs for many years. In fact, she looks fresh-faced and healthy. Most people would probably be surprised to learn that Carrie has bipolar disorder, which was diagnosed when she was 22 years old “after a retrospective look at my behaviors and moods over the years,” she said. Leading up to that, she’d experienced anxiety beginning at age 9. Then, at age 12 came the first bouts of depression that brought with it an “obsession with suicides and death.” At that point in her life, Carrie, who was in the 7th grade, began to cut herself. This behavior continued on and off for the next 20 years. Her parents suspected nothing and they had no evidence to suggest their daughter was struggling emotionally. There was no hint of her underlying pain because Carrie continued to excel in school.

Immediately after her high school graduation Carrie moved to North Carolina where she experienced her first manic and hypomanic episodes, which included risky and potentially dangerous behavior, a marriage and divorced in under five months when she was 19. Her parents didn’t learn about her diminishing mental health until thoughts of suicide and “obsessive thoughts of people dying” drove her to check into the ER. Her symptoms precipitated an involuntary admission to the state psychiatric hospital.

She hit a low point five years ago when she checked herself into the hospital for suicidal thoughts. What she thought would be a week-long recovery period turned into a five-year leave of absence from her successful professional career. In April of this year -- nearly 20 years since her first depression, a trail of failed treatments behind her, a loss of $20,000 in medical expenses and unrelenting depression - Carrie found an article on ketamine, which led her to a listing of Dr. Joshua Kantrowitz’s research study on His was the only study on ketamine that provided an FDA-approved treatment during the study. Carrie’s decision to enroll in a research study was a desperate attempt to get better. She is by no means “fixed,” but she’s glad she gave research a try: “I went into the trial with little hope because I did not want to be disappointed if it didn't help especially knowing that all my previous treatment attempts had failed. Needless to say, I was happily surprised to show any improvement.” She added, “I have made the biggest leap thus far which is the reemergence of hope. Something has proved capable of improving my many years long battle with debilitating bipolar depression.”

Researcher’s Perspective
In the language of social media practitioners, the drug ketamine seems to be trending now in research institutes around the country. It’s being studied as a potential treatment for various psychiatric disorders, including depression and two years ago we reported on the progress of a number of NYSPI researchers seeking to learn more about its potential. Dr. Joshua Kantrowitz is now leading a pilot study investigating whether or not ketamine is effective in treating depression in people diagnosed with bipolar disorder, a type of depression that is notoriously difficult to treat. Once patients are screened and their diagnosis confirmed, they are treated with FDA-approved treatment for three weeks. “After that we re-rate them. If their depression hasn’t gotten better – if there’s no substantial change – we give them a dose of ketamine,” said Dr. Kantrowitz. Ketamine is an anesthetic that may be better known by its street name “Special K.” Patients are given a small dose of the drug through an IV over a period of about 40 minutes followed by D-cycloserine (DCS), an oral antibiotic approved for tuberculosis with demonstrated antidepressant effects. Dr. Kantrowitz is interested in whether DCS will sustain the improvement in symptoms from ketamine.

Patients also get an MRI during the ketamine infusion so researchers are able to see changes in glutamate levels. Unlike many medications on the market, ketamine works through a different neurotransmitter system, the glutamate system. By causing a surge in glutamate levels, ketamine makes people with depression feel better. The improvement is rapid – in prior studies most patients reported feeling better after a few hours - but transient, lasting only about 7-10 days. “Within four hours, people who are going to improve generally show some improvement,” said Dr. Kantrowitz of findings in the study so far. He added, “The improvement tends to peak one to three days afterwards...People tend to show at least a 20% improvement from their pre-ketamine depression level. Unfortunately, the effects don’t last more than a week, and my hope is that DCS will prolong the period of improvement.”

Following this pilot study, Dr. Kantrowitz hopes to do a large-scale trial to demonstrate ketamine and DCS’ combined effectiveness in large groups of people.

To learn more about this study, call 646-774-8726 or -6738.


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