Cited by 431Treatment of Major DepressionSuicide and Self-Harm StudiesElectroconvulsive Therapy Studies

Ketamine for Rapid Reduction of Suicidal Thoughts in Major Depression: A Midazolam-Controlled Randomized Clinical Trial

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Grunebaum, Michael F., Galfalvy, Hanga C., Choo, Tse-Hwei, Keilp, John G., Moitra, Vivek K., Parris, Michelle S., Marver, Julia E., Burke, Ainsley K. +4 more·2018·American Journal of Psychiatry

Abstract

OBJECTIVE: Pharmacotherapy to rapidly relieve suicidal ideation in depression may reduce suicide risk. Rapid reduction in suicidal thoughts after ketamine treatment has mostly been studied in patients with low levels of suicidal ideation. The authors tested the acute effect of adjunctive subanesthetic intravenous ketamine on clinically significant suicidal ideation in patients with major depressive disorder. METHOD: In a randomized clinical trial, adults (N=80) with current major depressive disorder and a score ≥4 on the Scale for Suicidal Ideation (SSI), of whom 54% (N=43) were taking antidepressant medication, were randomly assigned to receive ketamine or midazolam infusion. The primary outcome measure was SSI score 24 hours after infusion (at day 1). RESULTS: The reduction in SSI score at day 1 was 4.96 points greater for the ketamine group compared with the midazolam group (95% CI=2.33, 7.59; Cohen's d=0.75). The proportion of responders (defined as having a reduction ≥50% in SSI score) at day 1 was 55% for the ketamine group and 30% for the midazolam group (odds ratio=2.85, 95% CI=1.14, 7.15; number needed to treat=4.0). Improvement in the Profile of Mood States depression subscale was greater at day 1 for the ketamine group compared with the midazolam group (estimate=7.65, 95% CI=1.36, 13.94), and this effect mediated 33.6% of ketamine's effect on SSI score. Side effects were short-lived, and clinical improvement was maintained for up to 6 weeks with additional optimized standard pharmacotherapy in an uncontrolled follow-up. CONCLUSIONS: Adjunctive ketamine demonstrated a greater reduction in clinically significant suicidal ideation in depressed patients within 24 hours compared with midazolam, partially independently of antidepressant effect.

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  1. [4]4. Meltzer HY, Alphs L, Green AI, et al: Clozapine treatment for suicidality in schizophrenia: International Suicide Prevention Trial (InterSePT). Arch Gen Psychiatry 2003; 60:82-91

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Authors
Grunebaum, M. F., Galfalvy, H. C., Choo, T.-H., Keilp, J. G., Moitra, V. K., Parris, M. S., Marver, J. E., Burke, A. K., Milak, M. S., Sublette, M. E., Oquendo, M. A., & Mann, J. J.
Affiliations
  • Columbia University Irving Medical Center (US)
  • From the Molecular Imaging and Neuropathology Division, Department of Psychiatry, and the Department of Anesthesiology, Columbia University Medical Center and New York State Psychiatric Institute, New York.
Venue
American Journal of Psychiatry
Published
2018-04-01
Volume
175
Issue
4
Pages
327-335
ISSN
  • 0002-953X (ISSN-L)
  • 1535-7228
OpenAlex
W2771797851
Cited by
431
References
47
Citations by year
2026: 31 · 2025: 45 · 2024: 52 · 2023: 57 · 2022: 62 · 2021: 54 · 2020: 55 · 2019: 43 · 2018: 31 · 2017: 1
FWCI
24.83
Type
journal article
Language
en
Open access
Locations
  • American Journal of Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of Mental Health (R01MH096784)
Topics
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Health Sciences › Medicine › Psychiatry and Mental health › Electroconvulsive Therapy Studies
Keywords
ketamine, midazolam, suicidal ideation, major depressive disorder, rapid-acting antidepressants, adjunctive pharmacotherapy, suicide risk reduction, antidepressant effects, mediation analysis
MeSH terms
Behavior Rating Scale, Suicide Prevention, Adult, Depressive Disorder, Major, Major Depressive Disorder, Double-Blind Method, Female, Humans, Infusions, Intravenous, Ketamine, Male, Midazolam, Middle Aged, Suicide, Young Adult, Suicidal Ideation

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