Ketamine Safe for Acutely Suicidal Patients in the Emergency Department Setting

A single infusion of ketamine is a safe and feasible treatment option for suicidal patients presenting to the emergency department, according to study results published in Depression and Anxiety.

Enrollees who presented at the University of Alabama at Birmingham’s emergency department were included if they met the criteria for major depression, bipolar depression, or depression not otherwise specified (NOS), according to the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, or dysthymia as confirmed by the Mini International Neuropsychiatric Interview. Clinically significant and active suicidal ideation was assessed using the Beck Scale for Suicidal Ideation and Columbia Scale for Suicide Severity Rating.

The trial enrolled 18 patients with acute suicidal ideation who required hospitalization. An equal number of patients were randomly assigned to receive either intravenous ketamine 0.2 mg/kg or a saline placebo. After 90 minutes of infusion, 88% of the ketamine group had achieved remission of suicidal ideation compared with 33% of the placebo group (P <.05). No serious adverse events were noted. As a secondary objective, investigators looked at ketamine’s effect on depressive symptoms and suicide‐related constructs: hopelessness, pessimistic thoughts, anxiety, and impulsivity. There was no statistically significant difference seen at any time in depression or impulsivity. However, 3 days post-infusion, there was a reduction of 90.7% in the Beck Hopelessness Scale scores compared with 17.5% in the control group (P <.05). Investigators saw a decrease in pessimistic thoughts per the ninth question of the Montgomery–Åsberg Depression Rating Scale starting at 15 minutes after ketamine infusion and lasting to day 3. Anxiety was used to assess potential threats; 3 days after infusion, there was an 82.4% reduction of baseline Beck Anxiety Index scores compared with 47.3% in individuals who received placebo (P <.05).

The study was limited by the small sample size.

“A single infusion of ketamine, administered in the emergency department, is a safe and feasible treatment option for depressed, suicidal patients. We found it to alleviate suicidal ideation in the first hours after infusion,” the investigators concluded. “Future larger‐scale studies should consider using a higher dose of ketamine (0.5 mg/kg) and addressing a transdiagnostic approach.”

Reference

Domany Y, Shelton RC, McCullumsmith CB. Ketamine for acute suicidal ideation. An emergency department intervention: a randomized, double-blind, placebo-controlled, proof-of-concept trial [published online November 16, 2019]. Depress Anxiety. doi:10.1002/da.22975