Repeated doses of intravenous (IV) ketamine quickly reduced suicidal ideation in pharmacologically treated outpatients with treatment-resistant depression with stable suicidal thoughts, according to a study published in the Journal of Clinical Psychiatry

Ketamine is known to rapidly reduce suicidal ideation in patients with treatment-resistant depression who are at low risk for suicide but its reduction of suicidal ideation in depressed patients with current suicidal ideation is not known, explained Dawn F. Ionescu, MD. 

Dr. Ionescu and coauthors recruited outpatients with major depressive disorder according to the DSM-IV criteria (n=14) between April 2012 and October 2013. The patients had current, stable (≥3 months) suicidal thoughts, and were given open-label ketamine infusions over 3 weeks. The primary outcome for this secondary analysis was 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]) at 240 minutes post-infusion and a follow-up for 3 months. 

During the acute treatment phase, 50% of the patients (7/14) demonstrated remission of suicidal ideation on the C-SSRS Ideation scale, even among patients whose depression did not remit. Study authors further observed a significant linear decrease in this score over time (P<0.001) even after controlling for severity of 6-item Hamilton Depression Rating Scale (HDRS6) core depression items (P=0.05). Also during this course, significant decreases in C-SSRS Intensity (P<0.01) and HDRS28-SI (P<0.001) scores were seen. 

Throughout the 3-month follow-up, two of the seven patients (29%) who achieved remission during the acute treatment phase, maintained their remission. 

Findings from the preliminary study showed that repeated doses of IV ketamine led to rapid and sustained reductions in suicidal ideation for outpatients with treatment-resistant depression with presence of current suicidal thoughts.

“We only studied intravenous ketamine, but this result opens the possibility for studying oral and intranasal doses, which may ease administration for patients in suicidal crises,” said Dr. Ionescu.

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