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Ketamine for acute suicidal ideation. An emergency department intervention: A randomized, double‐blind, placebo‐controlled, proof‐of‐concept trial
Author(s) -
Domany Yoav,
Shelton Richard C.,
McCullumsmith Cheryl B.
Publication year - 2020
Publication title -
depression and anxiety
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.634
H-Index - 129
eISSN - 1520-6394
pISSN - 1091-4269
DOI - 10.1002/da.22975
Subject(s) - suicidal ideation , ketamine , placebo , randomized controlled trial , medicine , emergency department , anesthesia , adverse effect , psychiatry , poison control , physical therapy , suicide prevention , emergency medicine , alternative medicine , pathology
Background Depressed patients presenting to emergency departments with acute suicidal ideation are a major public health concern. Ketamine, a rapidly acting antidepressant with antisuicidal properties, might offer relief. Methods In a randomized, double‐blind, placebo‐controlled, proof‐of‐concept trial, 18 depressed subjects with acute suicidal ideation, who required hospitalization, were randomized to either an intravenous ketamine 0.2 mg/kg group or a saline placebo group. Safety and efficacy evaluations were scheduled for 15, 30, 60, 90, 120, 180, and 240 min, and on Days 1, 2, 3, 7, and 14 after infusion. The main outcome measure was suicidal ideation with secondary measures of depression. Results Nine subjects were randomized to each group. There were no differences between groups at baseline in any demographic or assessment scales. A reduction in suicidal ideation was noted at 90–180 min ( p < .05). Ninety minutes after infusion, 88% of the ketamine group had achieved remission of suicidal ideation compared with 33% in the placebo group ( p < .05). No serious adverse events were noted. Conclusions Ketamine was safe and effective for rapid reduction in suicidal ideation in depressed, highly suicidal subjects presenting to the emergency department. Our results support further study of ketamine for acute suicidal ideation.