Is ketamine efficacious for rapid treatment of acute suicidal ideation in an emergency setting? Lessons learned from a pilot randomized controlled trial.
Maryam Barzkar, Kaveh Alavi, Kazem Malakouti, Mohamad-Amin Khajeh-Azad, Farzaneh Barzkar, Amir Hossein Jalali Nadoushan, Mohammad Niakan Lahiji
BMC research notes February 12, 2025 DOI: 10.1186/s13104-024-07029-7 (opens in new tab) via PubMed
Summary
AI-generated from the abstractA single infusion of ketamine did not outperform midazolam in rapidly reducing severe suicidal ideation among acutely suicidal inpatients. In a double-blind randomized controlled trial with 36 participants, both groups showed significant decreases in suicidality scores on the Beck Scale for Suicide Ideation and the Suicide-Visual Analog Scale at 12 and 24 hours after treatment, but the differences between the groups were not statistically significant. The midazolam group had higher baseline suicidality scores and a higher rate of borderline personality disorder, complicating comparisons.
Study at a glance
| Characteristics | Randomized controlled trial Double-blind Peer reviewed |
|---|---|
| Sample size | 36 |
| Population | Inpatients with acute severe suicidal ideation in Tehran, Iran |
| Interventions | Ketamine Midazolam |
| Dose | 0.5 mg/kg ketamine; 0.02 mg/kg midazolam |
| Duration | 24 hours post-administration |
| Topics | Depression Ketamine |
| Keywords | Midazolam N-methyl-d-aspartate receptor antagonist Suicide prevention |
| Citations | 1 |
| Key finding | Ketamine was not statistically significantly superior to midazolam in reducing severe suicidal ideation at 12 or 24 hours post-infusion. |
Abstract
This study aimed to evaluate the efficacy of a single infusion of ketamine in inducing rapid remission of severe suicidal ideation, compared to Midazolam, in a population with acute suicidal thoughts. In a double-blind randomized controlled trial conducted in Tehran, Iran, from January to July 2022 (IRCT20220118053756N1), 36 inpatients with acute severe suicidal ideation were enrolled. Participants were randomly assigned to receive either a single dose of ketamine (0.5 mg/kg) or Midazolam (0.02 mg/kg). Suicidality was assessed using the Beck Scale for Suicide Ideation (BSSI) and the Suicide-Visual Analog Scale (S-VAS) before the intervention and at 12 and 24 h post-administration. At baseline, the Midazolam group exhibited significantly higher BSSI scores and a higher rate of borderline personality disorder than the Ketamine group. Mean BSSI and S-VAS scores at 12 and 24 h after the treatment decreased significantly compared to baseline in both groups. Despite these observations, no statistically significant differences were found between the groups in terms of BSSI and S-VAS scores. The protocol for this RCT was registered at the Iranian Registry of Clinical Trials (IRCT). The trial registration details are as follows: IRCT registration number IRCT20220118053756N1, with the registration date being June 12, 2022 (1401/03/22). It is important to note that this trial was retrospectively registered.