Ketamine Shown to Reduce Suicidal Ideation in Severely Depressed Patients

Abstract

Back to table of contents Previous article Next article Clinical and Research NewsFull AccessKetamine Shown to Reduce Suicidal Ideation in Severely Depressed PatientsRebecca GreenbergRebecca GreenbergSearch for more papers by this authorPublished Online:22 Jan 2018https://doi.org/10.1176/appi.pn.2018.1b3AbstractKetamine is showing promise as a treatment for suicidal ideation.A single adjunctive infusion of ketamine reduces suicidal thoughts in severely depressed patients within 24 hours and remains effective for up to six weeks, according to a preliminary study published last month in AJP in Advance. The findings build on a meta-analysis showing that ketamine relieved suicidal symptoms for up to one week after infusion. For the study, Michael F. Grunebaum, M.D., and colleagues at Columbia University Medical Center and the New York State Psychiatric Institute randomly assigned 80 adults with major depressive disorder and suicidal ideation to receive ketamine or midazolam infusions. Of the sample, 54 percent were taking antidepressant medication. After infusions, patients received additional medications for six months, individually tailored to what researchers thought would work best for each patient.The researchers assessed participants’ suicidal ideation using the clinician-rated Scale for Suicidal Ideation (SSI) at baseline. The SSI is scaled from 0 (least severe) to 2 (most severe) and consists of 19 items that probe the patient’s wish to die, passive and active suicide attempt thoughts, duration and frequency of ideation, sense of control, deterrents, and preparatory behavior for an attempt. This assessment was repeated 24 hours before infusion with ketamine or midazolam, 230 minutes after infusion, 24 hours after infusion, and at weeks one to six after infusion. Patients were also asked about symptoms of depression and anxiety before and after the infusion, as well as adverse effects following the infusion and again at six-week follow-up.Within 24 hours of patients’ having received intravenous ketamine (0.5 mg/kg in 100 mL saline) or midazolam (0.02 mg/kg in 100 mL saline) infused over 40 minutes, patients in the ketamine group experienced a greater reduction in SSI score than that of the midazolam group. The proportion of patients whose scores improved by 50 percent or greater 24 hours after receiving an infusion was 55 percent for the ketamine group and 30 percent for the midazolam group. Compared with the midazolam group, the ketamine group also experienced greater reductions in overall mood disturbance, depression, and fatigue within 24 hours as measured by the Profile of Mood States.“Longitudinal analysis of the uncontrolled six-week follow-up showed that clinical improvement after randomized and open ketamine treatment was generally maintained through six weeks of open, optimized clinical follow-up treatment with respect to SSI score and depression ratings,” Grunebaum and colleagues wrote. Patients in the ketamine group experienced an increase in blood pressure and dissociative symptoms compared with patients in the midazolam group, but these adverse effects typically resolved within minutes to hours following the infusion.Further testing could elicit more about the drug’s potential to relieve depression and suicide risk, Grunebaum told Psychiatric News. It could even provide the basis for a new generation of antidepressants that work by a different mechanism, he added.“The next questions we would like to answer about ketamine as an adjunctive or mono therapy relate to strategies and safety of long-term treatment, for example, over months or years,” Grunebaum said. “With its mechanism of action, we hope to facilitate the development of new medications that work faster and help more people with fewer side effects than currently available drugs.“For most people, serious depression is a chronic relapsing, remitting, often lifelong illness. Given the promising shorter-term results for ketamine, it would be clinically important to study strategies [for administering it] and safety for longer-term treatment.” ■“Ketamine for Rapid Reduction of Suicidal Thoughts in Major Depression: A Midazolam-Controlled Randomized Clinical Trial” can be accessed here. “The Effect of a Single Dose of Intravenous Ketamine on Suicidal Ideation: A Systematic Review and Individual Participant Data Meta-Analysis” is available here. ISSUES NewArchived