Large review of bipolar disorder treatments lists ketamine add-on among effective options

The question

Which treatments for bipolar disorder are supported by the strongest evidence, broken down by mood phase (depression, mania or maintenance) and by age group?

What they did

Researchers searched PubMed, PsycInfo and the Cochrane library from their start dates to 19 November 2024 for systematic reviews that pooled randomized controlled trials of drug, nutritional supplement, talk therapy, brain stimulation or body-clock based treatments for bipolar disorder. They included 77 such reviews (21 network meta-analyses and 56 pairwise meta-analyses), covering 116 different treatments and five control conditions. Each result was rated for certainty using the standard GRADE system, and the findings were put into a free public web tool to support treatment discussions between patients and clinicians.

What they found

The review covered 133 different outcomes (45 about benefit, 88 about safety), producing 2510 separate meta-analyses. Certainty of the evidence was rated high for 236 of these, moderate for 827, low for 986 and very low for 461. For bipolar depression in adults, treatments judged effective across outcomes included ketamine used as an add-on to existing treatment, alongside cariprazine, divalproex or valproate, fluoxetine, lamotrigine, lumateperone, lurasidone, olanzapine, olanzapine with fluoxetine, and quetiapine. In children and adolescents with bipolar depression, only lurasidone and olanzapine with fluoxetine were listed as effective. Ketamine did not appear among the treatments listed as effective for mania or for long-term maintenance.

The fine print

This is a review of other reviews, so its conclusions depend on the quality of the original trials, and most of the pooled results were rated low or very low certainty. The abstract does not say how many patients or trials sat behind the ketamine result, what doses or formulations were used, or how long benefits lasted. Ketamine is one of 116 treatments examined here, not the focus of the review. This summary is based on the abstract only.

What it means

In a broad evidence map of bipolar disorder care, ketamine added to ongoing treatment appears among the options with support for the depressed phase in adults, but it sits alongside many better-established drugs and the abstract gives no detail on the strength of that specific finding.

Evidence grade: Moderate. An umbrella review pooling 77 existing meta-analyses of randomized trials, but the ketamine finding is one result among 2510 analyses and the abstract does not report its sample size or certainty rating.

This summary is based on the study’s published abstract.