Citation

Gaither R, Ranney M, Peachey A, Burock J, Rogers J, Bucci L, Beaudoin FL. J. Am. Coll. Emerg. Physicians Open 2022; 3(4).

Copyright

(Copyright © 2022, John Wiley and Sons)

DOI

10.1002/emp2.12790

PMID

unavailable

Abstract

OBJECTIVE: Mood disorders complicated by suicidal ideation (SI) frequently present to the emergency department (ED) for care. Currently, patients with SI in the ED do not typically receive targeted interventions. Ketamine may have a role in treating SI within the ED because subanesthetic doses have rapid-acting antidepressant and antisuicidal properties.

METHODS: This single-arm, open-label feasibility study enrolled 14 participants from the ED with acute SI who were awaiting voluntary admission to inpatient psychiatry to receive ketamine at 0.5 mg/kg, administered intravenously. Participants were assessed post administration to evaluate feasibility of administration in the ED and short-term effectiveness. Feasibility was determined by acceptability by patients and physicians as well as tolerability and ability to recruit participants into the study. Efficacy was assessed based on changes in (1) self-reported mood and (2) suicidal ideation pre- and postinfusion of ketamine.

RESULTS: All patients reported severe depression and active SI at baseline. No serious adverse events were reported, and acceptability was rated highly by both participants and physicians (>70%). Two hours after receiving ketamine 0.5 mg/kg, the mean SI and somatic symptom burden were decreased compared to baseline (P < 0.001 and P = 0.005, respectively), and the mean self-reported mood was increased (P = 0.006). Improvements in mood and decreases in suicidality persisted at 6 hours.

CONCLUSIONS: Overall, ketamine was well tolerated, considered feasible by both participants and physicians, and demonstrated short-term efficacy. There is a growing body of evidence demonstrating the feasibility of ketamine administration in the ED, and larger randomized trials should be conducted to establish treatment recommendations for patients with SI in the ED. © 2022 The Authors. JACEP Open published by Wiley Periodicals LLC on behalf of American College of Emergency Physicians.

Language: en

Keywords

adult; human; suicide; female; male; pilot study; ketamine; suicidal ideation; depression; mood; clinical trial; hospital; drug efficacy; high risk patient; drug tolerance; low drug dose; Center for Epidemiological Studies Depression Scale; Article; feasibility study; Columbia suicide severity rating scale; mood disorder assessment; emergency service; immediate mood scaler; side effect assessment; side effect rating scale for dissociative anesthetics