Rapid Resolution of Suicidal Ideation After a Single Infusion of anN-Methyl-D-Aspartate Antagonist in Patients With Treatment-Resistant Major Depressive Disorder
Nancy Diazgranados, Lobna Ibrahim, Nancy E. Brutsché, Rezvan Ameli, Ioline D. Henter, David A. Luckenbaugh, Rodrigo Machado‐Vieira, Carlos A. Zarate
The Journal of Clinical Psychiatry July 13, 2010 DOI: 10.4088/jcp.09m05327blu (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Open-label trial Peer reviewed |
|---|---|
| Sample size | 33 |
| Population | Subjects with DSM-IV-diagnosed treatment-resistant major depressive disorder |
| Intervention | Ketamine |
| Dose | 0.5 mg/kg |
| Duration | Single infusion, rated at baseline and at 40, 80, 120, and 230 minutes postinfusion |
| Topics | Anxiety Depression Ketamine |
| Keywords | Suicidal ideation Beck depression inventory Context archaeology Depression economics Ketamine hydrochloride Antidepressant Rating scale Anesthesia Poison control Suicide prevention Emergency medicine |
| Citations | 563 |
| Registration | NCT00088699 |
| Key findings | Suicidal ideation scores decreased significantly within 40 minutes of a single ketamine infusion and remained improved for up to 4 hours postinfusion. |
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.
In the evidence
This study is part of the evidence base for 2 syntheses in the library. Here is how each one recorded it.
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Depression, anxiety, and hopelessness were significantly improved at all time points after a single ketamine infusion.
Synthesized
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Suicidal ideation scores decreased significantly within 40 minutes of a single ketamine infusion and remained improved through 4 hours postinfusion.
Synthesized
Comparable studies
Other non-randomized and open-label trials on ketamine for anxiety, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Brain-Derived Neurotrophic Factor and Initial Antidepressant Response to anN-Methyl-D-Aspartate Antagonist Adults aged 18 to 65 years with DSM-IV major depressive disorder (treatment resistant) | 2009 | Open-label trial | n = 23 |
| Effect of Baseline Anxious Depression on Initial and Sustained Antidepressant Response to Ketamine Inpatients with treatment-resistant major depressive disorder | 2014 | Post hoc analysis of a single-arm open-label trial | n = 26 |
| A single infusion of ketamine improves depression scores in patients with anxious bipolar depression Patients with anxious (n=21) and non-anxious (n=15) treatment-resistant bipolar... | 2014 | Post-hoc analysis of a clinical trial | n = 36 |
| Safety and efficacy of extended release ketamine tablets in patients with treatment-resistant depression and anxiety: open label pilot study Patients with treatment-resistant depression/anxiety who had previously demonstrated... | 2020 | Open-label flexible dose uncontrolled study | n = 7 |
| Ketamine-assisted psychotherapy provides lasting and effective results in the treatment of depression, anxiety and post traumatic stress disorder at 3 and 6 months: Findings from a large single-arm retrospective effectiveness trial Adults with a history of depression, anxiety, or PTSD who had not responded to prior... | 2023 | Retrospective single-arm effectiveness trial | n = 1,806 |