Ketamine for Suicidality in Bipolar Depression

INCLUSION CRITERIA:

* Bipolar depression with current major depressive episode (MDE). Participants may be psychiatric medication-free, or if on psychiatric medication, not responding adequately given current MDE with suicidal ideation.
* Moderate to severe suicidal ideation
* 18-65 years old
* Patients will only be enrolled if they agree to voluntary admission to an inpatient research unit at the New York State Psychiatric Institute (NYSPI) for infusion phase of treatment.
* Pre-menopausal female participants of child-bearing potential must be willing to use an acceptable form of birth control during study participation such as condoms, diaphragm, oral contraceptive pills
* Able to provide informed consent
* Subjects 61-65 years old must score 25 or higher on the Mini-Mental State Examination (MMSE) at screening

EXCLUSION CRITERIA:

* Unstable medical condition or neurological illness, including baseline hypertension (BP\>140/90) or significant history of cardiovascular illness
* Significant ECG abnormality
* Pregnancy and/or lactation
* Current psychotic symptoms
* Contraindication to any study treatment
* Current or past ketamine abuse or dependence ever (lifetime); any other drug or alcohol dependence within past 6 months; suicidality only due to binge substance use or withdrawal
* Inadequate understanding of English
* Prior ineffective trial of or adverse reaction to ketamine or midazolam
* Opiate use greater than total daily dose of 20mg Oxycodone or equivalent during the 3 days pre-infusion