Ketamine for rapid reduction of suicidal ideation: a randomized controlled trial
James W. Murrough, Laili Soleimani, Kaitlin E. DeWilde, Katherine A. Collins, Kyle Lapidus, Brian M. Iacoviello, Marc S. Lener, Marin Kautz, J. Kim, Jessica Stern, Rebecca B Price, Andrew M. Perez, Jess W. Brallier, Gloria J. Rodriguez, Wayne K. Goodman, Dan V. Iosifescu, Dennis S. Charney
Psychological Medicine August 12, 2015 DOI: 10.1017/s0033291715001506 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Randomized controlled trial Peer reviewed |
|---|---|
| Sample size | 24 |
| Population | Patients with mood and anxiety spectrum disorders who presented with clinically significant suicidal ideation |
| Interventions | Ketamine Midazolam |
| Duration | Single infusion, primary assessment at 24 hours, with additional measures over 7 days |
| Topics | Anxiety Ketamine Esketamine |
| Keywords | Suicidal ideation Tolerability Randomized controlled trial Placebo Ketamine hydrochloride Anesthesia Adverse effect Poison control Injury prevention |
| Citations | 297 |
| Key findings | Ketamine did not significantly reduce suicidal ideation compared to midazolam at 24 hours on the primary outcome, but a significant difference emerged at 48 hours. |
Abstract
Background: Suicide is a devastating public health problem and very few biological treatments have been found to be effective for quickly reducing the intensity of suicidal ideation (SI). We have previously shown that a single dose of ketamine, a glutamate N-methyl-d-aspartate (NMDA) receptor antagonist, is associated with a rapid reduction in depressive symptom severity and SI in patients with treatment-resistant depression.
Method: We conducted a randomized, controlled trial of ketamine in patients with mood and anxiety spectrum disorders who presented with clinically significant SI (n = 24). Patients received a single infusion of ketamine or midazolam (as an active placebo) in addition to standard of care. SI measured using the Beck Scale for Suicidal Ideation (BSI) 24 h post-treatment represented the primary outcome. Secondary outcomes included the Montgomery-Asberg Depression Rating Scale--Suicidal Ideation (MADRS-SI) score at 24 h and additional measures beyond the 24-h time-point.
Results: The intervention was well tolerated and no dropouts occurred during the primary 7-day assessment period. BSI score was not different between the treatment groups at 24 h (p = 0.32); however, a significant difference emerged at 48 h (p = 0.047). MADRS-SI score was lower in the ketamine group compared to midazolam group at 24 h (p = 0.05). The treatment effect was no longer significant at the end of the 7-day assessment period.
Conclusions: The current findings provide initial support for the safety and tolerability of ketamine as an intervention for SI in patients who are at elevated risk for suicidal behavior. Larger, well-powered studies are warranted.