Single, Fixed-Dose Intranasal Ketamine for Alleviation of Acute Suicidal Ideation. An Emergency Department, Trans-Diagnostic Approach: A Randomized, Double-Blind, Placebo-Controlled, Proof-of-Concept Trial

Suicidal patients often present to the emergency department, where specific anti-suicidal treatment is lacking. Ketamine, a Glutamate modulator and a rapidly acting antidepressant with anti-suicidal properties, might offer relief. Evaluation of single, fixed-dosed intranasal ketamine for acute suici...

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Bibliographic Details
Published in:Archives of suicide research 2022-07, Vol.26 (3), p.1250-1265
Main Authors: Domany, Yoav, McCullumsmith, Cheryl B.
Format: Article
Language:English
Subjects:
Alleviation
Antidepressants
Double-blind studies
Efficacy
emergency department
Emergency services
Hospitalization
intra-nasal
Ketamine
Management
Medical diagnosis
Mental depression
Nasal sprays
Psychiatric hospitals
Remission (Medicine)
Suicidal ideation
Suicide
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Summary:Suicidal patients often present to the emergency department, where specific anti-suicidal treatment is lacking. Ketamine, a Glutamate modulator and a rapidly acting antidepressant with anti-suicidal properties, might offer relief. Evaluation of single, fixed-dosed intranasal ketamine for acute suicidal ideation in the emergency department. Between August 2016 and April 2018, 30 eligible suicidal subjects, scheduled for psychiatric hospitalization, independently of their psychiatric diagnosis, were randomized to intranasal ketamine 40 mg or saline placebo. Safety and efficacy evaluations were scheduled for 30, 60, 120 and 240 min post administration and on days 1, 2, 3, 4, 5, 7, 21 and 28. Primary outcome was suicidal ideation. Fifteen subjects were randomized for each study group. All were analyzed for primary and secondary outcomes. Four hours post administration, the mean difference in suicidal symptoms between the groups, measured by the Montgomery-Åsberg Depression Rating Scale (MADRS) item of suicidal thoughts (MADRS-SI), was 1.267 (95% confident interval 0.1-2.43, p 
ISSN:1381-1118
1543-6136
DOI:10.1080/13811118.2021.1878078