S-Ketamine in the treatment of depressive emergencies: a cases series of patients in a suicidal crisis
Bernhard T Baune, Z. Susam, V. Falcone, C. Knümann, P. Sarkheil, Erhan Kavakbasi
European Psychiatry June 1, 2022 DOI: 10.1192/j.eurpsy.2022.1446 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Case series Case report Peer reviewed |
|---|---|
| Sample size | 10 |
| Population | Patients with major depressive disorder in a psychiatric emergency setting |
| Intervention | S-ketamine intranasally |
| Topics | Depression Ketamine Esketamine |
| Keywords | Suicidal ideation Depression economics Poison control Suicide prevention Emergency medicine Mood |
| Key findings | Intranasal S-ketamine reduced depressive symptoms and suicidal ideation in treatment-resistant MDD patients in an acute psychiatric setting. |
Abstract
Introduction: Psychiatric emergencies in Major Depressive Disorder (MDD) are characterised by multiple types of symptoms including risk of self-harm and suicidal ideation. S-ketamine intranasally (Spravato) has recently been shown to help alleviate symptoms during depressive emergencies. In this case-series, we detail the clinical effects and usability of S-ketamine applied intranasally in a psychiatric emergency setting.
Objectives: To describe the effects of S-Ketamine on depressive crises associated with suicidality and self-harm in a psychiatric emergency setting.
Methods: Patients with MDD in a psychiatric emergency were provided with intranasal S-Ketamine according to clinical indication in routine clinical care in a University inpatient setting. Clinical characteristics were assessed in a standardised manner and symptom measures were applied pre-and posttreatment. Experience with 10 patients is systematically described in this case-series.
Results: Patients had a primary diagnosis of MDD accompanied by a variety of secondary psychiatric comorbidity. Among these 10 patients, the majority were female (70 %) and the mean age was 49.5 yrs (range 26-66). All cases were considered treatment resistant and suffered severe acute suicidal ideation. Across all cases, pre-treatment MADRS was 37 on average (range 20-47) indicating a severe form of MDD. High severity was confirmed in elevated BDI scores (pre-treatment 39). Post-treatment, MADRS scores were reduced to 18 on average, alongside BDI scores (mean 24). S-ketamine administration was well-tolerated and side effects such as dissociation were of short-lived duration.
Conclusions: S-Ketamine intranasally can be safely and effectively administered in an acute psychiatric setting to treat psychiatric emergencies. Disclosure BTB received honoraria for consultancy and presentations from AstraZeneca, Bristol-Myers Squibb, Lundbeck, Pfizer, Servier, Wyeth, LivaNova, Janssen, Novartis, Otsuka, Angelini.
Comparable studies
Other case reports and case series on esketamine for depression, most cited first.