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Ketamine for rapid reduction of suicidal ideation: a randomized controlled trial
Journal article   Peer reviewed

Ketamine for rapid reduction of suicidal ideation: a randomized controlled trial

J W Murrough, L Soleimani, K E DeWilde, K A Collins, K A Lapidus, B M Iacoviello, M Lener, M Kautz, J Kim, J B Stern, …
Psychological medicine, v 45(16), pp 3571-3580
Dec 2015
PMID: 26266877

Abstract

Adult Bipolar Disorder - epidemiology Depression - drug therapy Depressive Disorder, Major - epidemiology Double-Blind Method Excitatory Amino Acid Antagonists - administration & dosage Excitatory Amino Acid Antagonists - therapeutic use Female Humans Ketamine - administration & dosage Ketamine - therapeutic use Male Middle Aged Psychiatric Status Rating Scales Stress Disorders, Post-Traumatic - epidemiology Suicidal Ideation Treatment Outcome
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. 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. 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. 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.

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Collaboration types
Domestic collaboration
Web of Science research areas
Psychiatry
Psychology
Psychology, Clinical
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