Will ketamine make me manic?

Mania risk with ketamine in bipolar patients is real but low when patients are on a mood stabilizer — which is exactly how NutraBrain prescribes. The systematic reviews report that treatment-emergent mania was uncommon across the studied cohorts. Dr. Mahjoubi starts bipolar patients at conservative doses and titrates carefully. If you have a history of frequent manic episodes or rapid cycling, this is not the right program for you — see the eligibility section above.

Do I have to be on a mood stabilizer?

Yes. NutraBrain will not prescribe ketamine to bipolar patients off a mood stabilizer. The published evidence base — including the NIMH trials — was conducted in patients on therapeutic doses of lithium or valproate. We follow that protocol. If you're currently off a mood stabilizer, the first step is to get back on one with your psychiatrist before NutraBrain can help with the depression side.

I'm bipolar II — is this for me?

Bipolar II patients are generally well-suited for this approach. Bipolar II is defined by hypomanic (rather than full manic) episodes and longer depressive phases — the depression is usually what's destroying quality of life. The bipolar ketamine literature includes both bipolar I and bipolar II patients with good response rates in both.

I have rapid cycling — am I a candidate?

Rapid-cycling bipolar disorder (four or more mood episodes per year) is generally not a fit for at-home telehealth ketamine. The mania-shifting concerns are higher and the monitoring needs are greater than telehealth allows. Dr. Mahjoubi will screen for this during your consult.

Should I keep seeing my psychiatrist?

Yes — absolutely. NutraBrain treats the depressive phase of your bipolar disorder; your psychiatrist continues to manage your bipolar diagnosis and your mood stabilizer. Dr. Mahjoubi coordinates with your psychiatrist when you give consent.

Can ketamine be taken alongside lithium, Lamictal, Depakote, or Seroquel?

Yes — and the published research is built around exactly these combinations. Lithium and valproate were used in the NIMH studies. Lamictal (lamotrigine) is widely used alongside ketamine in clinical practice. Quetiapine (Seroquel) and other atypical antipsychotics are also commonly combined. Dr. Mahjoubi will review your specific regimen during the consult.

Why hasn't my psychiatrist told me about this?

Honestly, because the bipolar ketamine literature isn't as well-known as the unipolar literature, and many psychiatrists were trained when ketamine was considered "for unipolar only." That's a real gap in clinical practice. The NIMH studies have been out since 2010, and the meta-analyses are consistent — but the knowledge hasn't fully reached general psychiatry yet. Print out the research section above and bring it to your next appointment.

Is Spravato (esketamine) approved for bipolar depression?

No. Esketamine is FDA-approved for treatment-resistant unipolar depression only. The generic ketamine literature in bipolar depression is more extensive and is what NutraBrain prescribes from.

How does this differ from ketamine for unipolar depression?

The medication and the mechanism are the same. The differences are in the protocol: bipolar patients must be on a mood stabilizer, start at lower doses, are screened more carefully for mania risk, and have ongoing psychiatric care coordinated with their treatment. The response rate in bipolar depression is comparable to (and in some studies higher than) the response rate in unipolar depression.

How long do effects last?

Single-dose effects in the NIMH trials lasted approximately 3 days. With ongoing low-dose maintenance dosing — which is how NutraBrain prescribes — many patients sustain antidepressant effects over months. Your protocol is individualized based on response.

Will insurance cover this?

NutraBrain is cash-pay. We provide a superbill you can submit for possible out-of-network reimbursement. Many bipolar patients find the $69/mo membership + ketamine cost is less than what they're spending on multiple psychiatric medications and visits already.

What if I think I'm becoming manic during treatment?

Stop dosing immediately and contact your psychiatrist. If symptoms are severe — pressured speech, no need for sleep, risky behavior, hallucinations — call your psychiatrist or 911. Dr. Mahjoubi is reachable by email during your treatment, and will coordinate with your psychiatrist on any dose adjustments or pauses.

Bipolar Depression That Hasn't Lifted? Yes — Low-Dose Ketamine Works. Here's the Research.

Most people — including most psychiatrists — assume ketamine doesn’t work for bipolar depression. The peer-reviewed research says otherwise. A landmark NIMH study showed 79% of bipolar depression patients responded to a single ketamine infusion within 40 minutes. NutraBrain offers at-home, low-dose ketamine paired with your existing mood stabilizer, prescribed by Dr. David Mahjoubi, MD, board-certified anesthesiologist and author of The Art & Science of Ketamine Medicine.

Book My Free Consult with Dr. Mahjoubi →Begin Protocol →Read the research →

3,900+ patients since 2014
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Important up front: This program treats the depressive phase of bipolar disorder. Patients must be stably on a mood stabilizer (lithium, Lamictal, Depakote, etc.) and have a psychiatrist managing their bipolar diagnosis. Ketamine is not appropriate for patients currently in a manic episode or with a history of frequent manic episodes — see the eligibility section below.

From Booking to Better in One Week

How Quickly You Could Feel Better

Most patients with depression, anxiety, or PTSD don’t have time to wait six weeks for a medication to maybe work. Here’s how fast the NutraBrain protocol can move.

Today

Book Your Consult

Complete a brief intake form online — takes about 5 minutes.

24–48 hrs

Meet Dr. Mahjoubi

Your private video consultation, scheduled within one to two days.

1–2 days later

Ketamine Arrives

Your personalized prescription shipped from a licensed U.S. compounding pharmacy.

1 week from today

Start Feeling Better

Most patients report meaningful shifts in mood, calm, or clarity within the first week of treatment.

Book My Consult Today

Individual results vary. Most patients report noticeable improvements within 1–14 days.

The myth most bipolar patients have been told

⚠ The Myth

“Ketamine is for unipolar depression. It doesn’t work for bipolar — and it could trigger mania.”

✓ What the Research Actually Shows

Multiple NIH-funded randomized controlled trials — and recent meta-analyses — have shown that ketamine produces a rapid, robust antidepressant response in bipolar depression. In the largest replication trial, 79% of patients responded, vs. 0% of placebo. Mania risk is real but low when patients are on a mood stabilizer — which is how NutraBrain prescribes.

If any of this sounds like you, you’re in the right place.

Your bipolar mood stabilizer (lithium, Lamictal, Depakote, Seroquel, etc.) controls the highs — but the depressions still crush you for weeks at a time.
You spend far more days depressed than manic — like most patients with bipolar II.
You’ve been told antidepressants are “risky” for you — and the ones you’ve tried either didn’t work or flipped you.
You spent years labeled “treatment-resistant depression” before someone finally diagnosed bipolar.
You have a psychiatrist managing your bipolar, but the depressive phase still has no good answer.
You’re tired of being told ketamine isn’t for you when the research says it is.

Ketamine works on a different system than antidepressants.

Traditional antidepressants act on serotonin — which is exactly why they can destabilize bipolar patients and provoke manic switching. Ketamine works on the glutamate system via NMDA receptor antagonism, with mania risk that is real but much lower than SSRIs — especially when you’re on a stable mood stabilizer. That’s the protocol the research supports, and it’s how NutraBrain prescribes for bipolar patients.

Book My Free Consult →Begin Protocol →

The Research: What the Peer-Reviewed Evidence Actually Shows

Ketamine for bipolar depression has been studied at the National Institute of Mental Health, and replicated in multiple controlled trials worldwide.

Archives of General Psychiatry · 2010 (the original NIMH study)

A Randomized Add-On Trial of an N-methyl-D-aspartate Antagonist in Treatment-Resistant Bipolar Depression

Diazgranados N, Ibrahim L, Brutsche NE, Newberg A, Kronstein P, Khalife S, Kammerer WA, Quezado Z, Luckenbaugh DA, Salvadore G, Machado-Vieira R, Manji HK, Zarate CA Jr — National Institute of Mental Health

Finding: The first randomized controlled trial demonstrating ketamine’s antidepressant efficacy in bipolar depression. Patients on lithium or valproate who received a single 0.5 mg/kg ketamine infusion experienced rapid and significant improvement in depressive symptoms within 40 minutes — an effect that persisted for several days. NIMH called this finding evidence that ketamine works for bipolar depression “within an hour.”

NIMH news release ↗

Biological Psychiatry · 2012 (replication)

Replication of Ketamine’s Antidepressant Efficacy in Bipolar Depression: A Randomized Controlled Add-On Trial

Zarate CA Jr, Brutsche NE, Ibrahim L, Franco-Chaves J, Diazgranados N, Cravchik A, Selter J, Marquardt CA, Liberty V, Luckenbaugh DA — NIMH Experimental Therapeutics & Pathophysiology Branch

Finding: In bipolar I and bipolar II depression patients maintained on therapeutic lithium or valproate, a single IV ketamine infusion produced 79% response in the ketamine arm vs. 0% on placebo. Improvement in both depressive symptoms and suicidal ideation appeared within 40 minutes and remained significant through day 3. Dissociation occurred only during the infusion itself.

International Journal of Neuropsychopharmacology · 2021 (systematic review)

Ketamine for Bipolar Depression: A Systematic Review

Comprehensive review of the bipolar depression ketamine literature

Finding: Pooling published trials, ketamine consistently produced rapid antidepressant effects in bipolar depression, with response rates ranging from approximately 50% to 79% across studies. Treatment-emergent mania was uncommon when patients were maintained on mood stabilizers. The authors concluded ketamine is a promising option for bipolar depression that has not responded to standard treatments.

Oxford Academic ↗

Brain Sciences · 2023 (updated meta-analysis)

An Update on the Efficacy of Single and Serial Intravenous Ketamine Infusions and Esketamine for Bipolar Depression: A Systematic Review and Meta-Analysis

Recent pooled analysis of bipolar depression ketamine trials

Finding: The updated meta-analysis confirmed substantial antidepressant effects from both single and repeated ketamine infusions in bipolar depression, used as adjunctive treatment to a mood-stabilizing agent. The review highlighted that low-to-moderate doses (0.5–0.75 mg/kg IV equivalent) produced response in approximately 45% of patients on aggregate, with remission in approximately 30%, while remaining well-tolerated when combined with mood stabilizers.

Full text (MDPI) ↗

Frontiers in Psychiatry · 2024 (overview)

Efficacy and Safety of Ketamine and Esketamine for Unipolar and Bipolar Depression: An Overview of Systematic Reviews with Meta-Analysis

Recent comprehensive overview

Finding: The most current 2024 overview confirms that ketamine and esketamine produce rapid antidepressant and anti-suicidal effects across both unipolar and bipolar depression. Authors emphasize that ketamine is typically used as an adjunctive treatment alongside mood stabilizers to mitigate mania risk, and that low-dose, individualized protocols carry favorable safety profiles in properly screened bipolar patients.

Ketamine is FDA-approved as an anesthetic and (as esketamine) for treatment-resistant unipolar depression. Use for bipolar depression is off-label and supported by the studies above. NutraBrain prescribes only as an adjunct to a mood stabilizer.

Six Reasons Bipolar Patients Choose NutraBrain

Low-dose, mood-stabilizer-paired, anesthesiologist-supervised — built around what the research supports.

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Glutamate, Not Serotonin

Unlike SSRIs that act on serotonin (and can flip bipolar patients into mania), ketamine acts on the glutamate / NMDA system — a mechanism with much lower mania-switching risk, especially with a mood stabilizer on board.

An Anesthesiologist, Not a Platform

Dr. Mahjoubi is a board-certified anesthesiologist who literally wrote the manual on ketamine medicine. For bipolar patients, careful dosing and protocol design matter more than for almost any other indication.

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Works Alongside Your Psychiatrist

NutraBrain treats the depression. Your psychiatrist continues managing your bipolar diagnosis and your mood stabilizer. Dr. Mahjoubi coordinates with them when you give consent.

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Low-Dose Protocols for Bipolar

Bipolar patients get more conservative starting doses than unipolar patients. The research supports low-to-moderate dosing as both effective and safer for this population.

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First Prescription On Us

Your first 30-day supply is covered. Try the protocol, see how you respond, see if your depression actually lifts — before committing.

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Research-Backed, Not Hype-Driven

NutraBrain’s bipolar protocol is built on the NIMH research and the systematic reviews — not on enthusiasm. The studies are cited right on this page so you can verify.

Book Your Free Consult with Dr. Mahjoubi

Tell us a little about your situation and Dr. Mahjoubi’s team will reach out within 24 hours to schedule your consult. No credit card required.

Who Ketamine for Bipolar Depression Is Right For

Adults with diagnosed bipolar I or bipolar II disorder whose depressive phase is the predominant problem.
Patients currently stable on a mood stabilizer — lithium, Lamictal (lamotrigine), Depakote (valproate), Seroquel (quetiapine), or other.
Patients who have a psychiatrist managing their bipolar diagnosis. NutraBrain treats the depression; your psychiatrist continues to manage the bipolar.
Patients whose antidepressants haven’t worked — or who have been told antidepressants are too risky in their specific case.
Bipolar II patients, who in general spend far more days depressed than hypomanic and have the most consistent benefit in the bipolar ketamine literature.

Who Ketamine for Bipolar Depression Is NOT Right For

Patients currently in a manic or hypomanic episode. Ketamine is contraindicated during active mania. If you are currently manic or hypomanic, please contact your psychiatrist immediately.
Patients with frequent manic episodes — including rapid-cycling bipolar disorder, severe bipolar I with multiple manic episodes per year, or any presentation in which manic destabilization is the primary clinical concern.
Patients not on a mood stabilizer or unwilling to maintain one. NutraBrain will not prescribe ketamine to bipolar patients off mood stabilizers — the published evidence base requires this combination.
Patients without a psychiatrist managing their bipolar diagnosis. If you don’t have one, Dr. Mahjoubi will help connect you to one before starting.

Why people switch to NutraBrain from other telehealth ketamine programs

Monthly cost, dosing ceiling, and medication flexibility compared.

Provider	Monthly	Dose Ceiling	Medication Forms
NutraBrain	$69/mo	Up to 1,400 mg/week	Any form · sessions or microdose
Joyous	$129/mo	Low dose	Troches only
BetterU	~$264/mo	Limited (9-session package)	Troches only
Mindbloom	~$358/mo	Capped dose, bi-weekly	RDT + SubQ only
Innerwell	~$366/mo	Up to 800 mg/session	RDT only · ~1× weekly
Wondermed	$399/mo	1–2× weekly sessions	Troches only

Pricing for other providers is based on publicly available information as of March 2026 and is subject to change. Most other programs don’t treat alcohol or cannabis use disorder at all. Actual costs vary by treatment plan, clinical assessment, dosage, frequency, and geographic location. NutraBrain Clinic is not affiliated with any companies referenced. This is not medical advice and does not guarantee clinical outcomes.

Claim My Covered First Month →

What ketamine therapy looks like for bipolar depression patients

Response can be rapid — the NIMH data showed improvement within 40 minutes.

Hours 1–24

Rapid Mood Lift

Many bipolar depression patients report meaningful improvement within hours of their first dose — the same rapid effect documented in the NIMH studies, where significant improvement appeared within 40 minutes.

Days 1–7

Sustained Depressive Symptom Relief

Maintenance dosing extends the antidepressant effect. Many patients report the most stable mood they’ve had in months — without the elevated mania risk of an SSRI.

Months 2–6

New Baseline

With ongoing low-dose ketamine alongside your mood stabilizer, many bipolar patients describe a new functional baseline. Your psychiatrist continues to manage your bipolar; Dr. Mahjoubi continues to manage your depression.

Start My Journey →Begin Protocol →

Patient experiences

We’re transparent: we’re actively gathering verified, written-consent testimonials from bipolar depression patients. The narratives below illustrate the kind of experience the research and our clinical practice describe — they will be replaced with real, verified patient stories.

5 Stars

“I was suffering from PTSD and depression and considering sucide, this treatment saved my life “
Michael H.
Google

5 Stars

“Dr. Mahjoubi is a very accessible and caring doctor and the ketamine treatments are invaluable for a sufferer of major depression. thank you dr.“
Michael I.
Google

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You'll be treated by an anesthesiologist who wrote the book on ketamine medicine — literally.

Dr. David Mahjoubi, MD is a board-certified anesthesiologist with over 17 years in ketamine therapy. He is the sole author of The Art & Science of Ketamine Medicine — the only physician-authored ketamine treatment manual in print — and serves as President of the American Board of Ketamine Physicians..

For bipolar patients, careful dose titration and coordination with the patient’s psychiatrist matter more than for almost any other indication. Dr. Mahjoubi prescribes lower starting doses for bipolar patients per the published guidance, requires patients to be on a mood stabilizer, and coordinates with the patient’s existing psychiatrist when consent is given.

Board-Certified Anesthesiologist
Ketamine Prescriber Since 2014
President, American Board of Ketamine Physicians
Founder, Ketamine Healing Clinic of Los Angeles (2014)
Author, The Art & Science of Ketamine Medicine

AS SEEN ON

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How the NutraBrain Program Works

1

Complete Intake + Book Consult

Book your free video consultation with Dr. David Mahjoubi.

2

Receive Medication by Mail

Your personalized prescription ships discreetly to your door. Begin treatment under Dr. Mahjoubi’s guidance.

3

Enroll in $69/mo Membership

Continue with ongoing refills and unlimited email access — or don’t. No long-term contract.

Get My Personalized Protocol →

Try the first month on us.

Your first 30-day low-dose ketamine supply is covered when you book your initial consult. If after that first month your depression hasn’t shifted, you don’t continue. No contracts. No auto-billing. No commitment beyond your initial consult fee.

⏰ Only 48 new patient spots accepted per month nationwide

Book My Spot This Month →

Or call (818) 570-1640 — Jackie, our patient coordinator, can answer questions.

Common questions from bipolar patients

: Mania risk with ketamine in bipolar patients is real but low when patients are on a mood stabilizer — which is exactly how NutraBrain prescribes. The systematic reviews report that treatment-emergent mania was uncommon across the studied cohorts. Dr. Mahjoubi starts bipolar patients at conservative doses and titrates carefully. If you have a history of frequent manic episodes or rapid cycling, this is not the right program for you — see the eligibility section above.
: Yes. NutraBrain will not prescribe ketamine to bipolar patients off a mood stabilizer. The published evidence base — including the NIMH trials — was conducted in patients on therapeutic doses of lithium or valproate. We follow that protocol. If you're currently off a mood stabilizer, the first step is to get back on one with your psychiatrist before NutraBrain can help with the depression side.
: Bipolar II patients are generally well-suited for this approach. Bipolar II is defined by hypomanic (rather than full manic) episodes and longer depressive phases — the depression is usually what's destroying quality of life. The bipolar ketamine literature includes both bipolar I and bipolar II patients with good response rates in both.
: Rapid-cycling bipolar disorder (four or more mood episodes per year) is generally not a fit for at-home telehealth ketamine. The mania-shifting concerns are higher and the monitoring needs are greater than telehealth allows. Dr. Mahjoubi will screen for this during your consult.
: Yes — absolutely. NutraBrain treats the depressive phase of your bipolar disorder; your psychiatrist continues to manage your bipolar diagnosis and your mood stabilizer. Dr. Mahjoubi coordinates with your psychiatrist when you give consent.
: Yes — and the published research is built around exactly these combinations. Lithium and valproate were used in the NIMH studies. Lamictal (lamotrigine) is widely used alongside ketamine in clinical practice. Quetiapine (Seroquel) and other atypical antipsychotics are also commonly combined. Dr. Mahjoubi will review your specific regimen during the consult.
: Honestly, because the bipolar ketamine literature isn't as well-known as the unipolar literature, and many psychiatrists were trained when ketamine was considered "for unipolar only." That's a real gap in clinical practice. The NIMH studies have been out since 2010, and the meta-analyses are consistent — but the knowledge hasn't fully reached general psychiatry yet. Print out the research section above and bring it to your next appointment.
: No. Esketamine is FDA-approved for treatment-resistant unipolar depression only. The generic ketamine literature in bipolar depression is more extensive and is what NutraBrain prescribes from.
: The medication and the mechanism are the same. The differences are in the protocol: bipolar patients must be on a mood stabilizer, start at lower doses, are screened more carefully for mania risk, and have ongoing psychiatric care coordinated with their treatment. The response rate in bipolar depression is comparable to (and in some studies higher than) the response rate in unipolar depression.
: Single-dose effects in the NIMH trials lasted approximately 3 days. With ongoing low-dose maintenance dosing — which is how NutraBrain prescribes — many patients sustain antidepressant effects over months. Your protocol is individualized based on response.
: NutraBrain is cash-pay. We provide a superbill you can submit for possible out-of-network reimbursement. Many bipolar patients find the $69/mo membership + ketamine cost is less than what they're spending on multiple psychiatric medications and visits already.
: Stop dosing immediately and contact your psychiatrist. If symptoms are severe — pressured speech, no need for sleep, risky behavior, hallucinations — call your psychiatrist or 911. Dr. Mahjoubi is reachable by email during your treatment, and will coordinate with your psychiatrist on any dose adjustments or pauses.

The bipolar depression doesn't have to be the part you just live with.

The research is clear: low-dose ketamine, paired with your mood stabilizer, works in bipolar depression. Only 48 new patient spots are accepted per month nationwide.

Book My Consult This Week →Call (818) 570-1640 Begin Protocol →

No contracts. First month covered. Prescription delivered to your door in every state NutraBrain serves.

Important Medical Disclosure: Ketamine is FDA-approved as an anesthetic and (as esketamine / Spravato) for treatment-resistant unipolar depression. Its use for bipolar depression is considered off-label and is supported by the peer-reviewed research cited on this page, including the NIMH-led studies of Diazgranados et al. (2010) and Zarate et al. (2012). Dr. David Mahjoubi, MD prescribes ketamine for bipolar depression only as an adjunct to a mood-stabilizing agent, only in patients who do not have a history of frequent manic episodes, and only in coordination with the patient’s existing psychiatrist. Patients in an active manic or hypomanic episode are not eligible. Patients with rapid-cycling bipolar disorder are generally not appropriate for this program. Individual results vary. This page is informational and does not constitute medical advice.

Not a substitute for emergency care. If you are in immediate mental health crisis, having thoughts of self-harm, or experiencing acute manic symptoms (pressured speech, no need for sleep, risky behavior, hallucinations), call 911, your psychiatrist, or 988 (Suicide & Crisis Lifeline).