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2014 ; 58
(ä): 161-6
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Improvement in suicidal ideation after ketamine infusion: relationship to
reductions in depression and anxiety
#MMPMID25169854
Ballard ED
; Ionescu DF
; Vande Voort JL
; Niciu MJ
; Richards EM
; Luckenbaugh DA
; Brutsché NE
; Ameli R
; Furey ML
; Zarate CA Jr
J Psychiatr Res
2014[Nov]; 58
(ä): 161-6
PMID25169854
show ga
OBJECTIVE: Suicide is a psychiatric emergency. Currently, there are no approved
pharmacologic treatments for suicidal ideation. Ketamine is an
N-methyl-D-aspartate (NMDA) receptor antagonist that rapidly reduces suicidal
ideation as well as depression and anxiety, but the dynamic between these
symptoms is not known. The aim of this analysis was to evaluate whether ketamine
has an impact on suicidal thoughts, independent of depressive and anxiety
symptoms. METHODS: 133 patients with treatment-resistant depression (major
depressive disorder or bipolar I/II disorder) received a single subanesthetic
infusion of ketamine (0.5 mg/kg over 40 min). Post-hoc correlations and linear
mixed models evaluated the relationship between suicidal ideation and depression
and anxiety symptoms using the Hamilton Depression Rating Scale (HAMD), Scale for
Suicidal Ideation (SSI), Beck Depression Inventory (BDI), and Hamilton Anxiety
Rating Scale (HAMA) focusing on 230 min post-infusion. RESULTS: At 230 min
post-infusion, correlations between changes in suicidal ideation and depression
ranged from 0.23 to 0.44 (p < .05), accounting for up to 19% in the variance of
ideation change. Correlations with anxiety ranged from 0.23 to 0.40 (p < .05),
accounting for similar levels of variance. Ketamine infusion was associated with
significant reductions in suicidal ideation compared to placebo, when controlling
for the effects of ketamine on depression (F1,587 = 10.31, p = .001) and anxiety
(F1,567 = 8.54, p = .004). CONCLUSIONS: Improvements in suicidal ideation after
ketamine infusion are related to, but not completely driven by, improvements in
depression and anxiety. Investigation of the specific effects of ketamine on
suicidal thoughts is warranted.
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