Citation

Diazgranados N, Ibrahim LA, Brutsche NE, Ameli R, Henter ID, Luckenbaugh DA, Machado-Vieira R, Zarate CA. J. Clin. Psychiatry 2010; 71(12): 1605-1611.

Copyright

(Copyright © 2010, Physicians Postgraduate Press)

DOI

10.4088/JCP.09m05327blu

PMID

20673547

PMCID

PMC3012738

Abstract

OBJECTIVE: Suicidal ideation is a medical emergency, especially when severe. Little research has been done on pharmacologic interventions that could address this problem. Ketamine, an N-methyl-D-asparate antagonist, has been reported to have antidepressant effects within hours. We examined the effects of a single dose of ketamine on suicidal ideation in subjects with treatment-resistant major depressive disorder (MDD).
METHOD: Thirty-three subjects with DSM-IV-diagnosed MDD received a single open-label infusion of ketamine (0.5 mg/kg) and were rated at baseline and at 40, 80, 120, and 230 minutes postinfusion with the Scale for Suicide Ideation (SSI), the Montgomery-Åsberg Depression Rating Scale, the Hamilton Depression Rating Scale, and the Beck Depression Inventory. The study was conducted between October 2006 and January 2009.
RESULTS: Suicidal ideation scores decreased significantly on the SSI as well as on the suicide subscales of other rating instruments within 40 minutes; these decreases remained significant through the first 4 hours postinfusion (P <.001). Ten subjects (30%) had an SSI score ≥ 4 at baseline; all these scores dropped below 4 (9 dropped by 40 minutes and 1 by 80 minutes). For those patients with a starting score below 4 on the SSI, only 1 reached a score of 4. Depression, anxiety, and hopelessness were significantly improved at all time points (P <.001).
CONCLUSIONS: Suicidal ideation in the context of MDD improved within 40 minutes of a ketamine infusion and remained improved for up to 4 hours postinfusion. Future studies with ketamine in suicidal ideation are warranted due to the potential impact on public health.
TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00088699.

Language: en

Keywords

Humans; Adult; Female; Male; Middle Aged; Depression; Psychiatric Status Rating Scales; Time Factors; Treatment Outcome; Suicidal Ideation; Antidepressive Agents; Ketamine; Diagnostic and Statistical Manual of Mental Disorders; Infusions, Intravenous; Depressive Disorder, Major; Excitatory Amino Acid Antagonists; N-Methylaspartate