Subcutaneous ketamine reduces suicide risk and improves functioning in depression: A proof-of-concept study.
Ana Paula Anzolin, Daniel Prates Baldez, Bruno Braga Montezano, Flávio Kapczinski, Paulo Belmonte de Abreu, Márcia Kauer-Sant'Anna
Psychiatry Research July 1, 2024 DOI: 10.1016/j.psychres.2024.115915 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Naturalistic prospective observational study Peer reviewed |
|---|---|
| Sample size | 26 |
| Population | Patients with a current depressive episode at Hospital de Clínicas de Porto Alegre, Brazil |
| Intervention | subcutaneous ketamine |
| Dose | 0.5 mg/kg, adjusted according to individual responses |
| Duration | Acute phase (approximately eight sessions) and 6-month follow-up |
| Topics | Depression Ketamine Esketamine |
| Keywords | C-ssrs Suicidal ideation Mental health treatment Depression therapy Ketamine research Suicide prevention Psychiatric medicine |
| Citations | 2 |
| Registration | NCT05249309 |
| Key findings | Subcutaneous ketamine led to substantial decreases in Columbia Suicide Severity Rating Scale scores and depressive symptoms, with most patients achieving remission after about eight sessions, and a clear dose-response relationship was observed. |
Abstract
This investigation explores the efficacy of subcutaneous ketamine for mitigating depressive symptoms and suicidal ideation, addressing a crucial need for rapid-onset treatments in severe depression cases. It introduces an innovative approach to administering an NMDA receptor antagonist, significantly advancing psychopharmacological methods for treating suicidal behaviors as distinct entities, even within depressive episodes. The study's objective is to assess the impact of subcutaneous ketamine on diminishing suicidal thoughts and mood symptoms during depressive episodes through a naturalistic, prospective observational design. Conducted at Hospital de Clínicas de Porto Alegre, Brazil, between 2021 and 2023, the study involved 26 patients undergoing a current depressive episode. Of these, 23 completed the acute phase of treatment, and 18 were followed up for 6 months. The treatment regimen commenced with a ketamine dose of 0.5 mg/kg, which was adjusted according to individual responses under psychiatric supervision. The findings revealed substantial decreases in Columbia Suicide Severity Rating Scale scores following multiple ketamine sessions, with most patients achieving remission after approximately eight sessions. A notable reduction in depressive symptoms was also observed. A clear dose-response relationship was established, indicating that higher doses of ketamine were associated with more significant improvements in depressive symptoms, suicidal ideation, and overall functionality. Follow-up assessments suggested that these improvements were sustained over time. The subcutaneous administration of ketamine was generally well-tolerated, with minor and short-lived side effects. The study posits that subcutaneous ketamine may present a promising solution for treating severe depression accompanied by suicidal tendencies, particularly considering its positive influence on patient functionality and well-being. This method could offer a cost-effective and accessible treatment alternative, especially relevant in settings with limited resources. Given its potential in reducing long-term disability and economic viability, the study advocates for its broader application and further validation through larger, controlled trials. Trial Registration: ClinicalTrials.gov NCT05249309.
Comparable studies
Other observational and cohort studies on ketamine for depression, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Concomitant BDNF and sleep slow wave changes indicate ketamine-induced plasticity in major depressive disorder Patients with treatment-resistant major depressive disorder | 2012 | Observational cohort | n = 30 |
| Altered peripheral immune profiles in treatment-resistant depression: response to ketamine and prediction of treatment outcome Healthy controls and actively depressed patients with treatment-resistant depression... | 2017 | Observational cohort | n = 59 |
| Clinical Predictors of Ketamine Response in Treatment-Resistant Major Depression Treatment-resistant inpatients with DSM-IV-TR-diagnosed major depressive disorder or... | 2014 | Post hoc analysis of pooled data from four studies | n = 108 |
| An investigation of amino-acid neurotransmitters as potential predictors of clinical improvement to ketamine in depression Drug-free patients with major depressive disorder | 2011 | Observational cohort | n = 14 |
| Efficacy of ketamine therapy in the treatment of depression Drug-free/naïve men with severe depression, no history of psychotic disorder, head... | 2019 | Observational cohort | n = 25 |