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

Published online by Cambridge University Press:  12 August 2015

J. W. Murrough ,
L. Soleimani ,
K. E. DeWilde ,
K. A. Collins ,
K. A. Lapidus ,
B. M. Iacoviello ,
M. Lener ,
M. Kautz ,
J. Kim  and
J. B. Stern
...Show all authors
J. W. Murrough*
Affiliation:
Mood and Anxiety Disorders Program, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA Fishberg Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
L. Soleimani
Affiliation:
Mood and Anxiety Disorders Program, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
K. E. DeWilde
Affiliation:
Mood and Anxiety Disorders Program, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
K. A. Collins
Affiliation:
Mood and Anxiety Disorders Program, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
K. A. Lapidus
Affiliation:
Departments of Psychiatry and Neurobiology, Stony Brook University, Stony Brook, NY, USA
B. M. Iacoviello
Affiliation:
Mood and Anxiety Disorders Program, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
M. Lener
Affiliation:
Mood and Anxiety Disorders Program, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
M. Kautz
Affiliation:
Mood and Anxiety Disorders Program, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
J. Kim
Affiliation:
Deparment of Psychology, UCLA, Los Angeles, CA, USA
J. B. Stern
Affiliation:
Department of Psychology, Drexel University, Philadelphia, PA, USA
R. B. Price
Affiliation:
Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
A. M. Perez
Affiliation:
Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
J. W. Brallier
Affiliation:
Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
G. J. Rodriguez
Affiliation:
Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
W. K. Goodman
Affiliation:
Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
D. V. Iosifescu
Affiliation:
Mood and Anxiety Disorders Program, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA Fishberg Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
D. S. Charney
Affiliation:
Mood and Anxiety Disorders Program, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA Fishberg Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA Department of Pharmacology and Systems Therapeutics, Icahn School of Medicine at Mount Sinai, NY, New York, USA
*
*Address for correspondence: J. W. Murrough, M.D., Mood and Anxiety Disorders Program, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1230, New York, NY 10029, USA. (Email: [email protected])
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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.

Keywords

Depressionglutamateketaminesuicidetreatment
Type
Original Articles
Information
Psychological Medicine , Volume 45 , Issue 16 , December 2015 , pp. 3571 - 3580
Copyright
Copyright © Cambridge University Press 2015 

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