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Cited by 126Treatment of Major DepressionSuicide and Self-Harm StudiesElectroconvulsive Therapy Studies

Rapid and Sustained Reductions in Current Suicidal Ideation Following Repeated Doses of Intravenous Ketamine: Secondary Analysis of an Open-Label Study

Ionescu, Dawn F., Swee, Michaela B., Pavone, Kara J., Taylor, Norman, Akeju, Oluwaseun, Baer, Lee, Nyer, Maren, Cassano, Paolo +6 more·2016·The Journal of Clinical Psychiatry
DOI 10.4088/jcp.15m10056
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Abstract

BACKGROUND: Ketamine rapidly reduces thoughts of suicide in patients with treatment-resistant depression who are at low risk for suicide. However, the extent to which ketamine reduces thoughts of suicide in depressed patients with current suicidal ideation remains unknown. METHODS: Between April 2012 and October 2013, 14 outpatients with DSM-IV-diagnosed major depressive disorder were recruited for the presence of current, stable (≥ 3 months) suicidal thoughts. They received open-label ketamine infusions over 3 weeks (0.5 mg/kg over 45 minutes for the first 3 infusions; 0.75 mg/kg over 45 minutes for the last 3). In this secondary analysis, the primary outcome measures of suicidal ideation (Columbia-Suicide Severity Rating Scale [C-SSRS] and the Suicide Item of the 28-item Hamilton Depression Rating Scale [HDRS₂₈-SI]) were assessed at 240 minutes postinfusion and for 3 months thereafter in a naturalistic follow-up. RESULTS: Over the course of the infusions (acute treatment phase), 7 of 14 patients (50%) showed remission of suicidal ideation on the C-SSRS Ideation scale (even among patients whose depression did not remit). There was a significant linear decrease in this score over time (P < .001), which approached significance even after controlling for severity of 6-item Hamilton Depression Rating Scale (HDRS₆) core depression items (P = .05). Similarly, there were significant decreases in the C-SSRS Intensity (P < .01) and HDRS₂₈-SI (P < .001) scores during the acute treatment phase. Two of the 7 patients who achieved remission during the acute treatment phase (29%) maintained their remission throughout a 3-month naturalistic follow-up. CONCLUSIONS: In this preliminary study, repeated doses of open-label ketamine rapidly and robustly decreased suicidal ideation in pharmacologically treated outpatients with treatment-resistant depression with stable suicidal thoughts; this decrease was maintained for at least 3 months following the final ketamine infusion in 2 patients. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01582945.

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Authors
Ionescu, D. F., Swee, M. B., Pavone, K. J., Taylor, N., Akeju, O., Baer, L., Nyer, M., Cassano, P., Mischoulon, D., Alpert, J. E., Brown, E. N., Nock, M. K., Fava, M., & Cusin, C.
Affiliations
  • Harvard University (US)
  • Massachusetts General Hospital (US)
ORCID
Venue
The Journal of Clinical Psychiatry
Publisher
Physicians Postgraduate Press, Inc
Published
2016-05-10
Volume
77
Issue
06
Pages
e719-e725
ISSN
0160-6689 (ISSN-L)
DOI
10.4088/jcp.15m10056
OpenAlex
W2346471661
Cited by
126
References
0
Citations by year
2026: 4 · 2025: 6 · 2024: 7 · 2023: 12 · 2022: 10 · 2021: 13 · 2020: 16 · 2019: 12 · 2018: 29 · 2017: 15 · 2016: 2
FWCI
15.66
Type
journal article
Language
en
Open access
closed
Locations
  • The Journal of Clinical Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
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, suicidal ideation, major depressive disorder, treatment-resistant depression, intravenous ketamine infusion, suicide prevention, remission maintenance, Columbia Suicide Severity Rating Scale, Hamilton Depression Rating Scale
MeSH terms
Adolescent, Adult, Aged, Major Depressive Disorder, Dose-Response Relationship, Drug, Drug Administration Schedule, Female, Follow-Up Studies, Humans, Infusions, Intravenous, Ketamine, Male, Middle Aged, Psychiatric Status Rating Scales, Psychometrics, Remission Induction, Outcome Assessment, Health Care, Young Adult, Suicidal Ideation, Depressive Disorder, Treatment-Resistant

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