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


METHODS
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.
Mood and Anxiety Disorders Program,Department of Psychiatry,Icahn School of Medicine at Mount Sinai,New York,NY,USA.
J W
JW
Murrough
Mood and Anxiety Disorders Program,Department of Psychiatry,Icahn School of Medicine at Mount Sinai,New York,NY,USA.
L
L
Soleimani
Mood and Anxiety Disorders Program,Department of Psychiatry,Icahn School of Medicine at Mount Sinai,New York,NY,USA.
K E
KE
DeWilde
Mood and Anxiety Disorders Program,Department of Psychiatry,Icahn School of Medicine at Mount Sinai,New York,NY,USA.
K A
KA
Collins
Departments of Psychiatry and Neurobiology,Stony Brook University,Stony Brook,NY,USA.
K A
KA
Lapidus
Mood and Anxiety Disorders Program,Department of Psychiatry,Icahn School of Medicine at Mount Sinai,New York,NY,USA.
B M
BM
Iacoviello
Mood and Anxiety Disorders Program,Department of Psychiatry,Icahn School of Medicine at Mount Sinai,New York,NY,USA.
M
M
Lener
Mood and Anxiety Disorders Program,Department of Psychiatry,Icahn School of Medicine at Mount Sinai,New York,NY,USA.
M
M
Kautz
Deparment of Psychology,UCLA,Los Angeles,CA,USA.
J
J
Kim
Department of Psychology,Drexel University,Philadelphia,PA,USA.
J B
JB
Stern
Department of Psychiatry,University of Pittsburgh School of Medicine,Pittsburgh,PA,USA.
R B
RB
Price
Department of Anesthesiology,Icahn School of Medicine at Mount Sinai,New York,NY,USA.
A M
AM
Perez
Department of Anesthesiology,Icahn School of Medicine at Mount Sinai,New York,NY,USA.
J W
JW
Brallier
Department of Psychiatry,Icahn School of Medicine at Mount Sinai,New York,NY,USA.
G J
GJ
Rodriguez
Department of Psychiatry,Icahn School of Medicine at Mount Sinai,New York,NY,USA.
W K
WK
Goodman
Mood and Anxiety Disorders Program,Department of Psychiatry,Icahn School of Medicine at Mount Sinai,New York,NY,USA.
D V
DV
Iosifescu
Mood and Anxiety Disorders Program,Department of Psychiatry,Icahn School of Medicine at Mount Sinai,New York,NY,USA.
D S
DS
Charney
D000328:Adult; D001714:Bipolar Disorder / Q000453:epidemiology; D003863:Depression / Q000188:drug therapy*; D003865:Major Depressive Disorder / Q000453:epidemiology; D004311:Double-Blind Method; D018691:Excitatory Amino Acid Antagonists / Q000008:administration & dosage* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007649:Ketamine / Q000008:administration & dosage* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology; D059020:Suicidal Ideation; D016896:Treatment Outcome
D018691:Excitatory Amino Acid Antagonists; D007649:Ketamine
Depression; glutamate; ketamine; suicide; treatment