The Range of Bipolar Disorder
Bipolar Disorder is a “spectrum” illness with episodes that come in a range of forms (depression, mania, hypomania, mixed episodes, dysphoric hypomania) … cycles that can turn on a dime (episodic, rapid, ultradian) … and severity that ranges up one side and down another.
Wait a minute. What?
The episodes vary by type and in severity, the cycles vary in length and severity from one to another, the acceleration over time varies from one person to the next and even varies according to how many antidepressants are used, for how long, and how high … and the overall burden of illness varies from one person to the next.
So many variables.
So many things that can go wrong.
Some people are diagnosed as adults, others during adolescence, and some as children. At any age, it’s a tough illness to weather, as well as to effectively treat.
Still, some people are lucky. They can take certain medications like lamotrigine or lithium … or maybe Latuda or Vraylar … and experience balance along with some relief from their symptoms of depression and anger.
Others, however, really suffer.
If you’re one of them, you probably despise the depression. (Although you might love the mania…at first.) And you may not have experienced real help from mood stabilizers or antidepressants. After trying to control your symptoms with one medication after another, you can get just sick and tired of it.
The depressive episodes, especially. Most people with bipolar disorder say that that’s the worst part of it. Horrible. Long-lasting. Life-robbing. Often, your doctors will avoid using antidepressants — even though you may be secretly (or not so secretly) begging for an antidepressant, or for anything that could give you relief. They’re afraid it’ll flip you. Turn on mania. Accelerate cycling.
And so … what are you supposed to do…?
Just wait?
IV Ketamine is the Hero Again
The good news is that rising numbers of people with bipolar disorder are experiencing extraordinary relief of their depressive episodes with IV ketamine infusions, with remarkable results.
Bipolar Disorder is a mood disorder that can cause intense mood swings, racing thoughts, suicidal thinking, risky behaviors, and sometimes distorted perceptions. Moods can swing from deep, dark, despairing depression to mania… or hypomania… or terrible mixed states that last from hours to weeks or months … and then the next episode of depression takes over.
Talk about debilitating.
Unfortunately… effective treatment is all too often tough to find. It’s estimated that as few as 40% of people who 
suffer with this illness receive treatment that actually helps. That means 60% of patients have no real help.
What? 60%?
Even one person with no real help is too many.
As it stands, there’s no treatment that brings remission to 100% of people, but we work tirelessly to uncover everything possible that can make a difference in our patients’ lives.
Our goal, always, is to put episodes of illness into a remission that can stretch … to infinity. (What a great goal!) So that your best self can emerge for good.
Bipolar Disorder : IV Ketamine Isn’t a New Idea
As far back as 2010, studies were conducted with children, adolescents, and adults with bipolar disorder that were aimed at measuring the effect of ketamine on the symptoms they were experiencing. They hadn’t been helped by previous oral medications.
And even in those early studies, they reported improvement in depressed mood, but also anger, outbursts, night terrors, and suicidal thinking.
Since one of the symptoms we see in bipolar disorder is impulsivity, the intense depression, suicidal thinking, and agitation that can occur in the middle of the night and in the early morning hours — in a mixed state, or during an abrupt mood switch — is dangerous. When you combine impulsive decisions with recurrent thoughts of dying, the most devastating result can be suicide.
To try to prevent this, IV ketamine can be given to treat the suicidal thinking rapidly and to improve depressive symptoms.
Fear of Harm
Most data regarding IV ketamine and bipolar disorder focuses on the depressive symptoms. But… individuals with 
bipolar disorder who’ve been treated with IV ketamine are also reporting reductions in other symptoms like rage, violent outbursts, and racing thoughts.
One sub-type of bipolar disorder in children is known as “Fear of Harm.” There is a unique list of additional symptoms we see which are very different than those experienced by adults with Bipolar I or Bipolar II. Things like getting hot in the evening and through the night accompanied by terrifying dreams, fear of being hurt by others, and fear of violently hurting others in retaliation.
And as far back as 2010, children and adolescents with this diagnosis who were un-helped by oral medications were being successfully treated with ketamine. A series of doses removed their depression, their terrifying dreams, their rage, and their low self-esteem. They reported feeling much calmer, happier, and more relaxed. And they said they had far less rage, were sleeping better, and feeling confidence… and hope… about their futures. Their performance on school homework and exams also improved dramatically.
Some of these kids had no memory of ever feeling better before. Can you imagine…? So they described the new way they felt as a strange feeling for them, but they could tell it was good.
Can You Imagine?
Imagine never experiencing peace. Or trying to remember a time when you didn’t want to hurt someone… or when you didn’t want to die. But not being able to conjure such a feeling. Because you have absolutely no experience in your memory you can draw upon.
Then, imagine feeling peace, joy, relief… happiness….for the very first time in your life. Not for a minute or an hour, but for real. What would you give for that?
Most of the world takes for granted the natural ebb and flow of emotion that’s part of being human. But for the many who have bipolar disorder, it’s a dream beyond their grasp.
Until IV Ketamine.
Treatment is focused on the depressive symptoms, but when the depression is successfully treated, so are a cluster of other miseries.
Things like lack of control, thoughts about harming yourself or others, blinding rage, racing thoughts, mental 
confusion, violent outbursts… After a treatment regimen of IV ketamine, patients report these symptoms are greatly diminished or gone. And, another thing… while most patients report dramatic change in depressive symptoms during and shortly after the infusions, some experience the results gradually over weeks or months.
The trajectory changes.
You need to know this if you have any form of bipolar disorder: IV Ketamine is making people WELL.
Neuroscientists Keep Studying
There’s still lots to be learned about bipolar disorder and all its forms and types. And about all the ways it can be successfully treated. Neuroscientists are forging ahead to discover new ketamine-based wannabe drugs. What’s more, they’re also finding more ways ketamine works in the brain to heal the malfunctioning structures there.
As we’ve said before, we’ve embarked on a new journey in psychiatry, a new approach to treating mood disorders,
based on the remarkable and exciting ways that IV ketamine treatment is making people well. There is new hope for people with bipolar disorder: IV ketamine.
At this point, we’re seeing 80% of people who suffer from treatment-resistant depressive symptoms enjoying relief. They experience a dramatic reduction of symptoms, and often complete remission. If you have bipolar disorder in any form, you know that to dramatically reduce your symptoms would give you the power to live a fulfilling life.
But beyond that… remission? That’s a hope worth reaching for.
If you have been diagnosed with bipolar disorder and you have been treated but don’t feel you’ve improved, call or email me. You can also ask your doctor or therapist to contact us. We’d love to work with your healthcare team to help you find balance and peace in your life.
To the release of your very best self,
Lori Calabrese, M.D.
Hello: I just read your information on the use of ketamine for depression/mixed states and cycling.
Do you know of any psychiatrists practicing in the Denver area that you could recommend? Connecticut is too far for my family member to travel. Thank you so much for directing us to local resources.
Please call me with your contact information. I’d be happy to give you a referral.
I have bipolar with social /general anxiety. Will ketamine possibly help me? And is there a doctor in Cleveland Ohio area that would prescribe it?
Thank you
In many of the studies and in many clinical practices around the country, ketamine treatment is used to treat depressive episodes in bipolar disorder that have not responded to two or more medications — and it can work beautifully for the depressive episodes. It’s not a treatment for mania or an “overall” treatment for bipolar disorder. Also, it has not been studied as much for social anxiety as it has been studied for treatment-resistant depression unipolar and bipolar patients — but many of my patients with social anxiety find it really helps and reduces their social anxiety symptoms as well as reducing their depressive symptoms. A quick way to see if there is a psychiatrist near you in Ohio who offers ketamine treatment is to google “ketamine treatment near me” or “ketamine for depression” near me.
Hello I have been strugling with bipolor for 18yrs and not one Dr had given me what stage I am. I’ve been on all kinds of medications and still having problems. I cannot stay focused No desire to do nothing. I’m at my witts end I just want to feel normal .i live in Las Vegas. I’m so sick of these Dr’s I’ts pretty sad that psychiatrist are the only Doctor that does not examine or do physical testing of the brain they just guess. And you wonder why there are so many mental illness .
I’m sorry that’s been your experience. Bipolar disorder can cause so much suffering! I write about it all the time because I see so much of it and because it’s so prevalent. Psychiatrists, though, examine their patients each time they meet with what is called the Mental Status Examination — ask your doctor to explain the elements of this to you next time you go in. We also do physical testing when we order labs, neuroimaging (like CT scans and MRIs), genetic testing (with a cheek swab), and neuropsych testing. Bipolar disorder is a very difficult disorder, with so many complex symptoms that present themselves differently even in the same person, and so difficult to tease apart from other disorders that can co-exist with it. You can be really proud of yourself for not giving up and continuing to seek out the best possible treatment.
I have had Bipolar 2 for 20 + years now. I was able to find 7 years of relative “sanity” with 60 mg of Cymbalta. Well, that completely blew up in Feb 2019 and I have now been on a roller-coaster ride of medications trying to find one(s) that will help stable things out. I am glad I found this website. I cannot functionally do my job anymore. I can barely keep my wife and kids relationships going. I really need some help. Thinking and doing ANYTHING is unbearable and VERY exhausting. Even writing this comment is taking all of me to do it. Do you think Ketamine treatment would help my situation?
It can be very effective, even after a roller-coaster of medications. Although we can’t provide an individual recommendation here about whether it would help you, we offer a 1 hour comprehensive evaluation so that we can evaluate your symptoms, your treatment history, your medical conditions, and really talk to you about the risks and benefits, and the potential response for you personally. If you would like to schedule that, please call us at 860-648-9755.
Hello. I have had bipolar depression for several years. Lithium and Depakine had no effect. And I just put up with the fact that we don’t have ketamine therapy in Iran, and I agreed with an anesthesiologist to give me ketamine. He gave me a dose of 0.25. I actually went to a session and then I really understood the real world.
I am so glad my writing has reached you in Iran! Please share this with your doctor there, and particularly with your psychiatrist. I don’t know about the complexity of the medical care system in Iran, and how medications get approved and become available, but there is an extraordinary international conference coming up on ketamine treatment which will be held in Oxford, England in April 2021, and I will be speaking at it. It was slated for this past April, but postponed due to the pandemic. There is tremendous international interest by psychiatrists and basic scientists in studying and using IV ketamine for treatment of bipolar depression.
Please email me more info. My 15 year old is deeply suffering from a depressive episode. I’m in Alaska and would like to try and find a place near me.
Thank you
Deep suffering is so awful for the one suffering, and so hard on the family! There is so much information for you to read through for help. I’ll show you how to find it on my website. Across the top Menu bar, there are 3 places to fine great information: Meet, The Ketamine Blog and News. First, go to Meet. There is a photo in that sections of the research paper I published using IV ketamine to treat severe depression in adults and adolescents with severe depression and suicidal thoughts. The article is available and free to read online. Just google “titrated serial ketamine infusions” and it will pop up for you. Next, one of the best ways to search for information on my website is to go to to the top menu bar and click on The Ketamine Blog. There is a search bar to the right. Type in anything: teens, family, depression, suicidal thoughts, microbiome, BDNF, glutamate, dendritic branching– and all of the articles I’ve posted that talk about that will appear. It’s a great way to look up specific topics. Some of the articles research, others new findings, new information, or stories. Just scroll through the topics you are interested in. On The Ketamine Blog main page, I’ve also organized some main topics along the right side, so that you can also click there. Finally, News is the place where I post information from News sources about different aspects of ketamine treatment. Finally, you can learn more about ketamine treatment from pubmed.com, which indexes abstracts articles from the National Library of Medicine, and from Google Scholar. Best wishes to you, and especially, best wishes and new hope for your son!
I am searching for help for my son. He is bipolar, diagnosed when he was 18. He is 27 now. He lives in Oklahoma City and we have not been able to find much help for him. He worked his way through college receiving a business degree last year. He got a job as asst. manager of a bank branch. He is goes to counseling every week and takes a variety of medicines. He received a write up at work after he was told he looked like he was on drugs and explained to his manager that he was just dizzy from the bipolar medicine he took. They told him they had to meet with HR and he couldn’t go back to work without seeing his doctor. He is trying so hard to live a normal life. Can you help him? What can he do?
Please call me at (860) 648-9755. I have a lovely colleague who is a psychiatrist in Oklahoma whom he could see for a consultation and ketamine treatment.
Thank you so very much for your guidance!
I was hospitalized and diagnosed Bipolar 1 at age 14. I struggle more with depression and it’s been a rollercoaster for a couple of years now especially. My psychiatrist who I’ve been seeing since I was 14, just changed my meds from trintellix, rexulti and lamictal to vraylar, viibryd and still lamictal. I’m about two weeks into the beginning of tapering and changing. I’m hopeful. Not sure if I’m feeling what I should. My biggest complaint with my depression is the “fogginess”. The lack of ability to concentrate, think clearly, retain and remember…do my job as an RN.
Do you think ketamine would be something to help with these symptoms?
Although I can’t give specific medical advice or recommendations here, I would encourage you to share this post with your psychiatrist, and to explore the categories on the side bar because they group all of my posts by topic, like depression and bipolar disorder. Your doctor can assess whether some of the fogginess you experiences is coming from your medication or your depression itself. In general, when ketamine works to lift depression, mood and improved concentration are symptoms that clearly improve.
I have now lived with bipolar 2 for about 29 years. The disease progressed over the decades to the point that I was literally immobilized by anxiety and depression. While a handful of the dozen medications I’ve tried over the years offered some relief, none seem to adequately relieve the severe depression, apathy, self loathing and anger/anxiety. As of April 2020 my medication regiment consisted of Ativan, Wellbutrin, Gabapentin and Abilify. Even with 4 different medications my average day would be graded as D+/ C-. I was hopeless. It’s now June 29th 2020 and I’ve just completed my 6th round of Ketamine treatments. The results are undeniable and drastic. I have literally had a complete remission of the depression and anxiety and feel more alive and connected than I have since my mid 20’s. I would now rate my average day as a B+ / A-. A miraculous result. My only regret now is that I never found Ketamine sooner. I have also been able to stop taking Ativan, Abilify and Gabapentin and am slowly getting off the antidepressant. For those of you who read this and feel deep despair….there is hope !
How fantastic! Thank you for sharing this! I know that so many people who struggle with the same symptoms want to hear real stories from real people and sharing your story here will reach and help so many people who are looking for help. This is a wonderful way to pay it forward and do good in the world. Best wishes!
My concern with ketamine is that like I read, I think it was here, that it’s not a sole treatment…also the cost, is insurance paying for your treatments? Any more specifics you have I’d love to hear about.
Also, Dr. what do they say about ketamine and mania? My fear is that it could induce it…
Yes, it can induce hypomania and mania, and it must be used carefully and judiciously in bipolar disorder to avoid this.
Is ketamine just mainly for the depression side of Bipolar? I have depression, but I’m more mood & anger side! I have the racing thoughts (works continuously), anger like I said, terrible impulse control, hyper sexuality (other things were wrong but it hurt our marriage, divorce), diagnosed 24yrs ago, been on just about every Med known, hospitalized 3x’s and Soo on!
Yes, ketamine treatment is for the depressive episodes of bipolar disorder, not for mania or hypomania, and it is tricky to use in mixed states where there is a mix of both hypomanic and depressive symptoms. It must be used carefully in bipolar depression with close oversight because it has the potential to flip the switch and precipitate hypomania or mania.
My friend needs a drug for bad manic behavior. What do u think
I’m sorry to hear your friend is struggling. Ketamine can be used to treat the depressive episodes, or the chronic depression that we sometimes see in bipolar disorder, but it it not an appropriate treatment for mania.