Case ReportsAdjunctive music improves the tolerability of intravenous ketamine for bipolar depressionGreenway, Kyle T*,; Garel, Nicolas; Goyette, Nathalie; Turecki, Gustavo; Richard-Devantoy, Stephane*,Author Information Douglas Mental Health Research Institute, McGill University, McGill Group for Suicide Studies, Montréal, Québec, Canada *Kyle T Greenway and Stephane Richard-Devantoy both should be considered co-corresponding authors. Received 16 January 2021 Accepted 30 March 2021 Correspondence to Kyle T Greenway, MD MSc, Department of Psychiatry, McGill University, McGill Group for Suicide Studies, Douglas Mental Health University Institute, FBC building, 3rd floor, 6875 boulevard Lasalle, Montréal (Qc) H3W 2N1, Canada, Tel: +1 514 761 6131 x 3310; fax: +1 514 888 4466; e-mail: [email protected] International Clinical Psychopharmacology: July 2021 - Volume 36 - Issue 4 - p 218-220 doi: 10.1097/YIC.0000000000000363 Buy Metrics Abstract Intravenous ketamine is an effective treatment of bipolar depression. One of its most important side-effects is a transient altered state of consciousness commonly referred to as dissociation. These states can be anxiety-provoking, distressing and even treatment-limiting, warranting research into mitigation strategies. In this article, we present two cases that demonstrate the potential of adjunctive music to diminish the distress associated with ketamine-induced dissociation – though not necessarily its degree – in bipolar 1 disorder. Both patients suffering from severe depression underwent their first ketamine infusion without music and opted for music with subsequent infusions. They reported that music significantly improved the tolerance of their dissociative symptoms, thereby reducing distress and facilitating subsequent treatments. Both patients achieved remission from their highly treatment-resistant depressive episodes following six ketamine infusions. This is the first report of music’s benefits on ketamine for bipolar 1 depression, though there is precedence in the scientific literature on ‘psychedelics’ where the use of music in combination with medication-induced altered states has been studied. The principles regarding music selection that have resulted from this paradigm may be applicable to the use of ketamine in unipolar and bipolar depression. The optimal use of music with ketamine warrants further research. Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.