Jenko, Kimberly J; Anzilotti, Jack H
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Dr. Abby Massey
Date of Graduation
Background. Depression and suicide are common in the United States and present a significant problem in the healthcare landscape. Currently, there are few options that can rapidly reduce suicidal ideation in patients with depression. Ketamine, a glutamate N-methyl-D-aspartate (NMDA) receptor antagonist, has been shown to reduce acute suicidality in patients with depression. Previous studies have a reduction of suicidal ideation compared to saline placebo, but few studies have shown a significant effect compared to a similar psychoactive drug such as midazolam.
Method. A search of PubMed and PsychNET was performed in September 2018 using the terms “ketamine,” “suicide,” and “depression” with a filter for human clinical trials. Three randomized controlled trials were discovered that compared the effects of intravenous (IV) ketamine or midazolam on active, acute suicidal ideation in patients with a history of depression. Suicidal ideation and depression were measured using similar scales to allow for relative comparison between studies. Baseline measurements of suicidal ideation were assessed before IV administration of the randomized medications, and repeat assessments were obtained 24 hours after administration of the medication.
Results. All three studies evaluated showed a reduction in suicidal ideation in patients that received ketamine compared to those that received midazolam. Grunebaum et al. and Price et al. both saw statistically significant reductions in SI in patients who received ketamine and assessed with the Beck Scale for Suicidal Ideation (BSI) or the Scale for Suicidal Ideation (SSI). Murrough et al. observed a nonsignificant reduction in SI at 24 hours using the BSI, but did see a statistically significant reduction using the Montgomery-Asberg Depression Rating Scale (MADRS-SI). SI was reduced in the midazolam group in all studies, but none were significant, and none as extensive as the ketamine groups.
Conclusion. Ketamine administered at subanesthetic doses can provide acute relief of suicidal ideation in patients with depression within 24 hours.
Jenko KJ, Anzilotti JH. Subanesthetic IV ketamine reduces acute suicidal ideation in patients with mood disorders. JMU Scholarly Commons Physician Assistant Capstones.
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