The efficacy and safety of esketamine in the treatment of major depressive disorder with suicidal ideation: Study protocol for a randomized controlled trial

Background Major depressive disorder (MDD) is a high risk factor for suicide, with up to 20% of MDD patients attempting suicide during their lifetime. Current treatments for MDD are slow onset of action, low efficiency, and the inability to control suicidal behaviors quickly and effectively. Intravenous ketamine has been shown to have a rapid but […]

Clinical trials for rapid changes in suicidal ideation: Lessons from ketamine

Rapid-acting treatments for suicidal thoughts are critically needed. Consequently, there is a burgeoning literature exploring psychotherapeutic, pharmacologic, or device-based brief interventions for suicidal thoughts characterized by a rapid onset of action. Not only do these innovative treatments have potentially important clinical benefits to patient populations, they also highlight a number of methodological considerations for suicide […]

Real‑world depression, anxiety and safety outcomes of intramuscular ketamine treatment: A retrospective descriptive cohort study

Background: Ketamine has emerged as a promising pharmacotherapy for depression and other mental illnesses, and the intramuscular (IM) administration of ketamine is now offered at many North American outpatient psychiatric clinics. However, a characterization of the outpatient population receiving IM ketamine treatment and an evaluation of the real-world depression, anxiety, and safety outcomes of long-term psychiatric […]

Suicidal behavior: Advances in clinical and neurobiological research and improvement of prevention strategies

Suicide is the 14th leading cause of death worldwide. It is responsible for 1%-5% of all mortality. This article highlights the latest developments in universal, selective, and indicated prevention strategies. Concerning universal suicide prevention, current research has shown that strategies such as restricting access to lethal means (e.g., control of analgesics and hot-spots for suicide by […]

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

Background 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. Aims Evaluation of single, fixed-dosed intranasal ketamine for acute suicidal ideation in the emergency department. Methods Between August 2016 and April 2018, 30 eligible suicidal […]

The therapeutic effects of ketamine in mental health disorders: A narrative review

Ketamine, a non-competitive N-methyl-d-aspartate receptor antagonist, is commonly used as an anesthetic and analgesic but has recently shown promising research in treating certain psychiatric conditions such as depression, post-traumatic stress disorder (PTSD), suicidal ideation, and substance use disorder. Due to its euphoric, dissociative, and hallucinogenic properties, ketamine has been abused as a recreational drug, which […]

Computerized-adaptive vs. traditional ratings of depression and suicidal thoughts: An assay sensitivity pilot study in a ketamine clinical trial

There is a public health need for improved suicide risk assessment tools. This pilot methodology study compared the assay sensitivity of computerized adaptive tests (CAT) of depression and suicidal ideation vs. traditional ratings in a randomized trial subgroup. The last 20 persons to enroll in a published ketamine trial in suicidal depression were studied. This […]

Role of ketamine in the treatment of psychiatric disorders

Purpose of review This is a comprehensive review of the literature regarding the use of ketamine as a treatment for treatment-resistant depression (TRD). It covers the epidemiology, risk factors, pathophysiology, and current treatment modalities regarding Major Depressive Disorder (MDD) and TRD. It provides background on the mechanism of action of ketamine, its history, current approved […]

Ketamine for the acute treatment of severe suicidal ideation: Double blind, randomised placebo controlled trial

Objective To confirm the rapid onset anti-suicidal benefits of ketamine in the short term and at six weeks, overall and according to diagnostic group. Design Prospective, double blind, superiority, randomised placebo controlled trial. Setting Seven French teaching hospitals between 13 April 2015 and 12 March 2019. Eligibility criteria for participants Aged 18 or older with current suicidal ideation, admitted […]

Electrophysiological correlates and predictors of the antidepressant response to repeated ketamine infusions in treatment-resistant depression

Background: Sub-anesthetic ketamine doses rapidly reduce depressive symptoms, although additional investigations of the underlying neural mechanisms and the prediction of response outcomes are needed.  Electroencephalographic (EEG)-derived measures have shown promise in predicting antidepressant response to a variety of treatments, and are sensitive to ketamine administration. This study examined their utility in characterizing changes in depressive […]

The rapid anti-suicidal ideation effect of ketamine: A systematic review

In many countries suicide rates have been trending upwards for close to twenty years-presenting a public health crisis. Most suicide attempts and deaths are associated with psychiatric illness, usually a depressive disorder. Subanesthetic ketamine is the only FDA-approved antidepressant that works in hours not weeks-thus potentially transforming treatment of suicidal patients. We reviewed all randomized […]

The effect of a single dose of intravenous ketamine on suicidal ideation: A systematic review and individual participant data meta-analysis.

Objective: Suicide is a public health crisis with limited treatment options. The authors conducted a systematic review and individual participant data meta-analysis examining the effects of a single dose of ketamine on suicidal ideation. Method: Individual participant data were obtained from 10 of 11 identified comparison intervention studies that used either saline or midazolam as […]

Effects of intravenous ketamine in a patient with post-treatment Lyme disease syndrome.

Post-treatment Lyme disease syndrome (PTLDS) is a pain disorder for which there remains no gold standard treatment option. Here, we report a case of PTLDS in a female patient whose pain was refractory to treatment options such as radiofrequency ablation, vitamin infusion therapy, opioid analgesics, and other pharmacotherapies. The patient commenced an experimental intravenous ketamine […]

Ketamine use in current clinical practice.

After nearly half a century on the market, ketamine still occupies a unique corner in the medical armamentarium of anesthesiologists or clinicians treating pain. Over the last two decades, much research has been conducted highlighting the drug’s mechanisms of action, specifically those of its enantiomers. Nowadays, ketamine is also being utilized for pediatric pain control […]

Ketamine for rapid reduction of suicidal ideation: A randomized controlled trial.

Suicide is a devastating public health problem and very few biological treatments have been found to be effective for quickly reducing the intensity of suicidal ideation (SI). We have previously shown that a single dose of ketamine, a glutamate N-methyl-d-aspartate (NMDA) receptor antagonist, is associated with a rapid reduction in depressive symptom severity and SI in […]

Ketamine for depression, 2: Diagnostic and contextual indications.

This article examines diagnostic indications for the off-label use of ketamine as an antidepressant and possible contexts in which ketamine may be trialled. Contact us for a copy of this article, or view online at http://www.psychiatrist.com/JCP/article/_layouts/ppp.psych.controls/BinaryViewer.ashx?Article=/JCP/article/Pages/2017/v78n05/v78n0513.aspx&Type=Article

Effects of low-dose and very low-dose ketamine among patients with major depression: A systematic review and meta-analysis.

Background: Several recent trials indicate low-dose ketamine produces rapid antidepressant effects. However, uncertainty remains in several areas: dose response, consistency across patient groups, effects on suicidality, and possible biases arising from crossover trials. Conclusion: Low-dose ketamine appears more effective than very low dose. There is substantial heterogeneity in clinical response, with remission among one-fifth of […]

Does ketamine have anti-suicidal properties? Current status and future directions.

Ketamine, a widely used anesthetic agent, is currently being investigated as a novel therapeutic for depression and suicidality. Ketamine has garnered substantial attention from researchers, clinicians, media outlets, and patients alike, but numerous questions remain. One of the compelling features of ketamine is the rapidity of its antidepressant effects, which peak just 24 h after […]

Improvement in suicidal ideation after ketamine infusion: Relationship to reductions in depression and anxiety.

We investigated the effects of ketamine on suicidal ideation across clinical trials. Suicidal ideation, as independent from depression or anxiety, was evaluated. Depression accounted a limited amount of variance of change in suicidal thoughts. Ketamine had an effect on suicidal thoughts independent of depression and anxiety. Anxiety may be an important treatment target for suicide […]