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Ketamine augmentation for major depressive disorder and suicidal ideation: Preliminary experience in an inpatient psychiatry setting.

Mark Sinyor, Marissa Williams, Sue Belo, Beverley A Orser, Margaret Vincent, Linda Mah, Carlos A. Zarate, Saulo Castel, Anthony Levitt, Ayal Schaffer

Journal of Affective Disorders December 1, 2018 DOI: 10.1016/j.jad.2018.07.073 (opens in new tab)

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Study at a glance

AI-extracted from the abstract
Characteristics Case series Randomized Case report Peer reviewed
Sample size 5
Population Adults with major depressive disorder and suicidal ideation admitted to a tertiary care hospital in Toronto, Canada
Intervention Ketamine
Dose 0.5 mg/kg intravenous
Duration Six infusions over approximately 12 days, with follow-up at days 14 and 42
Measures Scale for Suicidal Ideation (SSI), Montgomery-Åsberg Depression Rating Scale (MADRS)
Topics Depression Ketamine Esketamine
Keywords Inpatients Midazolam Suicide
Key findings All five inpatients experienced benefit from six serial ketamine infusions: suicidal ideation scores dropped 84% (14.0 to 2.2 on the SSI) and depression scores dropped 47% (42.2 to 22.4 on the MADRS) by day 42. The authors describe these preliminary pilot data as promising and suggest six infusions may be safe and feasible, while noting the small sample size limits conclusions.

Abstract

Ketamine is known to rapidly reduce depressive symptoms and suicidal ideation (SI) in patients with major depressive disorder (MDD), but evidence is limited for its acceptability and effectiveness in "real-world" settings. This case series examines serial ketamine infusions in reducing SI and depression scores in adults with MDD admitted to a tertiary care hospital. Five inpatients with MDD and SI admitted to hospital in Toronto, Canada received six infusions of 0.5 mg/kg intravenous (IV) ketamine (n = 5) over approximately 12 days, in addition to treatment-as-usual. Suicide and depression rating scores (Scale for Suicidal Ideation, SSI; Montgomery-Åsberg Depression Rating Scale, MADRS) were obtained at baseline, on treatment days, on days 14 and 42 (primary endpoint). All patients experienced benefit with ketamine. SSI scores diminished by 84% from 14.0 ± 4.5 at baseline to 2.2 ± 2.5 at study endpoint. MADRS scores diminished by 47% from 42.2 ± 5.3 at baseline to 22.4 ± 8.0. Two patients withdrew from the study, one to initiate electroconvulsive therapy and one due to an adverse event (dissociative effects) during the ketamine infusion. The major limitation of this study is the small sample size. These preliminary pilot data are promising with a greater than two-fold reduction in SI following ketamine infusions. They demonstrate that six serial ketamine infusions may be safe and feasible. These findings support the need for large scale randomized controlled trials to confirm the efficacy of serial ketamine for treatment of SI in "real-world" settings.

Comparable studies

Other case reports and case series on ketamine for depression, most cited first.

Study Year Design Participants
Electroconvulsive Therapy, Ketamine, and Esketamine in a Patient with Major Depressive Disorder and Multiple Comorbidities: A Case Report over 10-year Treatment from Adolescence to Adulthood. A patient with treatment-resistant depression and comorbid generalized anxiety... 2025 Case report n = 1
Oral Administration of the NMDA Receptor Antagonist S-Ketamine as Add-On Therapy of Depression: A Case Series Four depressed patients taking standard antidepressants 2009 Case series n = 4
A longitudinal case series of IM ketamine for patients with severe and enduring eating disorders and comorbid treatment‐resistant depression Patients with enduring eating disorders and treatment-resistant depression 2021 Case series n = 4
Effects of intranasal (S)-ketamine on Veterans with co-morbid treatment-resistant depression and PTSD: A retrospective case series Veterans with co-morbid depression and PTSD 2022 Retrospective case series n = 35
Case report: Intramuscular ketamine or intranasal esketamine as a treatment in four patients with major depressive disorder and comorbid anorexia nervosa Patients with anorexia nervosa and a comorbid depressive disorder treated at a private... 2023 Case report n = 4

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