Tuesday, November 19, 2019

Ketamine Found to Rapidly Reduce Suicidal Thoughts in Depressed, Suicidal Patients in ER

Patients presenting to an emergency room with complaints of suicidal thoughts may experience relief from these thoughts within 90 minutes of a single, low-dose infusion of ketamine, suggests a small study in Depression & Anxiety.

While previous studies have demonstrated the potential of ketamine to reduce suicidal thoughts in patients with depression (including this 2017 paper published in the American Journal of Psychiatry), this new study examined the effectiveness of a low-dose infusion administered in an emergency department. “A single infusion of ketamine, administered in the emergency department, is a safe and feasible treatment option for depressed, suicidal patients,” wrote Yoav Domany, M.D., of Tel Aviv University and colleagues.

The study included 18 depressed patients aged 18 to 65 who were hospitalized after reporting suicidal ideation in an emergency room setting. After completing baseline assessments, the patients were randomly assigned to receive ketamine (0.2 mg/kg) or placebo (saline) intravenously over five minutes, under the supervision of an emergency department physician. The researchers evaluated the severity of the patients’ suicidal ideations (using the Beck Scale for Suicidal Ideation and item 10 of the Montgomery–├ůsberg Depression Rating Scale, or MADRS), feelings of depression and anxiety (using the MADRS and Beck Anxiety Index), dissociative symptoms, blood pressure, and more 15, 30, 60, 90, 120, 180, and 240 minutes after the infusion. The patients were evaluated again 1, 2, 3, 7, and 14 days later.

Domany and colleagues found that patients in the ketamine group reported fewer suicidal thoughts than those in the placebo group 90 to 180 minutes after the infusion. “Notably, 90 minutes after infusion, 88% of the ketamine‐receiving subjects were no longer actively suicidal compared with 33% of the controls,” the authors wrote. A total of 22% of patients in the ketamine group experienced what the authors referred to as “transient elevated systolic blood pressure” (higher than 140 mm/Hg), compared with 11% in the placebo group. There were no differences in psychiatric symptoms or dissociative symptoms between the two groups at any time point following the infusion.

“Our findings are consistent with others who demonstrated the antisuicidal effect of ketamine. … We, however, suggest here a more feasible way of administration, which is more appropriate for an emergency department setting (even before administration to psychiatric ward),” they wrote.

The authors noted the main limitation of the study was the small sample size of the trial and called for additional studies to examine the effectiveness of ketamine for reducing suicidal thoughts in this patient population.

For related news, see the Psychiatric News article “Ketamine Shown to Reduce Suicidal Ideation in Severely Depressed Patients” and the American Journal of Psychiatry article “Ketamine for Rapid Reduction of Suicidal Thoughts in Major Depression: A Midazolam-Controlled Randomized Clinical Trial.”

(Image: iStock/MJFelt)

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