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.
In the evidence
This study is part of the evidence base for a synthesis in the library. Here is how each one recorded it.
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Ketamine did not significantly reduce suicidal ideation versus midazolam at 24 hours on the primary outcome, but a significant difference emerged at 48 hours and the treatment effect was no longer significant by day 7.
Synthesized
Comparable studies
Other randomized controlled trials on ketamine for anxiety, most cited first.