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Psychol Med. 2015 Dec;45(16):3571-80. doi: 10.1017/S0033291715001506. Epub 2015 Aug 12.

Ketamine for rapid reduction of suicidal ideation: a randomized controlled trial.

Author information

1
Mood and Anxiety Disorders Program,Department of Psychiatry,Icahn School of Medicine at Mount Sinai,New York,NY,USA.
2
Departments of Psychiatry and Neurobiology,Stony Brook University,Stony Brook,NY,USA.
3
Deparment of Psychology,UCLA,Los Angeles,CA,USA.
4
Department of Psychology,Drexel University,Philadelphia,PA,USA.
5
Department of Psychiatry,University of Pittsburgh School of Medicine,Pittsburgh,PA,USA.
6
Department of Anesthesiology,Icahn School of Medicine at Mount Sinai,New York,NY,USA.
7
Department of Psychiatry,Icahn School of Medicine at Mount Sinai,New York,NY,USA.

Abstract

BACKGROUND:

Suicide is a devastating public health problem and very few biological treatments have been found to be effective for quickly reducing the intensity of suicidal ideation (SI). We have previously shown that a single dose of ketamine, a glutamate N-methyl-d-aspartate (NMDA) receptor antagonist, is associated with a rapid reduction in depressive symptom severity and SI in patients with treatment-resistant depression.

METHOD:

We conducted a randomized, controlled trial of ketamine in patients with mood and anxiety spectrum disorders who presented with clinically significant SI (n = 24). Patients received a single infusion of ketamine or midazolam (as an active placebo) in addition to standard of care. SI measured using the Beck Scale for Suicidal Ideation (BSI) 24 h post-treatment represented the primary outcome. Secondary outcomes included the Montgomery-Asberg Depression Rating Scale--Suicidal Ideation (MADRS-SI) score at 24 h and additional measures beyond the 24-h time-point.

RESULTS:

The intervention was well tolerated and no dropouts occurred during the primary 7-day assessment period. BSI score was not different between the treatment groups at 24 h (p = 0.32); however, a significant difference emerged at 48 h (p = 0.047). MADRS-SI score was lower in the ketamine group compared to midazolam group at 24 h (p = 0.05). The treatment effect was no longer significant at the end of the 7-day assessment period.

CONCLUSIONS:

The current findings provide initial support for the safety and tolerability of ketamine as an intervention for SI in patients who are at elevated risk for suicidal behavior. Larger, well-powered studies are warranted.

KEYWORDS:

Depression; glutamate; ketamine; suicide; treatment

PMID:
26266877
DOI:
10.1017/S0033291715001506
[Indexed for MEDLINE]
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