A Double-Blinded, Randomized, Placebo-Controlled Sub-Dissociative Dose Ketamine Pilot Study in the Treatment of Acute Depression and Suicidality in a Military Emergency Department Setting

Burger, John D.; Capobianco, Marc; Lovern, Robert; Boche, Ben; Ross, Elliot; Darracq, Michael A.; McLay, Robert N.

doi:10.7205/milmed-d-15-00431

Cited by 54 publications

(44 citation statements)

References 25 publications

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“…This study presents a novel research paradigm for suicide research: evaluation of ketamine's effect on specific RDoC constructs. This approach, which was suggested in our previous work (Mallick & McCullumsmith, 2016) and by others (Burger et al, 2016;DiazGranados et al, 2010;Price et al, 2014), may lead to a better understanding of the neurobiological constructs of the suicide phenomena. Our results point out the beneficial effect of ketamine on positive and negative valence systems, but not on cognitive control.…”

Section: Novelty and Importancementioning

confidence: 93%

Ketamine for acute suicidal ideation. An emergency department intervention: A randomized, double‐blind, placebo‐controlled, proof‐of‐concept trial

2019

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Background Depressed patients presenting to emergency departments with acute suicidal ideation are a major public health concern. Ketamine, a rapidly acting antidepressant with antisuicidal properties, might offer relief. Methods In a randomized, double‐blind, placebo‐controlled, proof‐of‐concept trial, 18 depressed subjects with acute suicidal ideation, who required hospitalization, were randomized to either an intravenous ketamine 0.2 mg/kg group or a saline placebo group. Safety and efficacy evaluations were scheduled for 15, 30, 60, 90, 120, 180, and 240 min, and on Days 1, 2, 3, 7, and 14 after infusion. The main outcome measure was suicidal ideation with secondary measures of depression. Results Nine subjects were randomized to each group. There were no differences between groups at baseline in any demographic or assessment scales. A reduction in suicidal ideation was noted at 90–180 min (p < .05). Ninety minutes after infusion, 88% of the ketamine group had achieved remission of suicidal ideation compared with 33% in the placebo group (p < .05). No serious adverse events were noted. Conclusions Ketamine was safe and effective for rapid reduction in suicidal ideation in depressed, highly suicidal subjects presenting to the emergency department. Our results support further study of ketamine for acute suicidal ideation.

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Section: Novelty and Importancementioning

confidence: 93%

Ketamine for acute suicidal ideation. An emergency department intervention: A randomized, double‐blind, placebo‐controlled, proof‐of‐concept trial

2019

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“…IV ketamine may have increased utility in specialized populations, such as the military, cancer patients, and patients with Alzheimer's disease. In active duty military populations, long-term psychiatric admission for suicidality may create unique problems including separating the patient from his or her support network and leading to administrative obstacles in returning to duty [37]. In one study on 10 soldiers in the United States, a single dose of IV ketamine (0.2 mg/kg) was found to significantly decrease suicidality and hopelessness [37].…”

Section: Ketamine and Depressionmentioning

confidence: 99%

“…In active duty military populations, long-term psychiatric admission for suicidality may create unique problems including separating the patient from his or her support network and leading to administrative obstacles in returning to duty [37]. In one study on 10 soldiers in the United States, a single dose of IV ketamine (0.2 mg/kg) was found to significantly decrease suicidality and hopelessness [37]. Ketamine appears to be a rapidly efficacious antidepressant and antisuicidal pharmacologic agent which may be well suited for this particular population and others in which long-term psychiatric hospitalization creates significant challenges, though it is possible that the particular applications for the US military may not translate to broader military use around the world.…”

Section: Ketamine and Depressionmentioning

confidence: 99%

A Review of Nonanesthetic Uses of Ketamine

Pribish

Wood

Kalava

2020

Anesthesiology Research and Practice

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Ketamine, a nonselective NMDA receptor antagonist, is used widely in medicine as an anesthetic agent. However, ketamine’s mechanisms of action lead to widespread physiological effects, some of which are now coming to the forefront of research for the treatment of diverse medical disorders. This paper aims at reviewing recent data on key nonanesthetic uses of ketamine in the current literature. MEDLINE, CINAHL, and Google Scholar databases were queried to find articles related to ketamine in the treatment of depression, pain syndromes including acute pain, chronic pain, and headache, neurologic applications including neuroprotection and seizures, and alcohol and substance use disorders. It can be concluded that ketamine has a potential role in the treatment of all of these conditions. However, research in this area is still in its early stages, and larger studies are required to evaluate ketamine’s efficacy for nonanesthetic purposes in the general population.

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“…In a small pilot study conducted in a military emergency department setting, Burger et al 20 randomized depressed and suicidal patients who met criteria for inpatient care to receive IV ketamine (0.2 mg/kg) or saline placebo. Two of 3 ketamine patients had dramatic reductions in suicidality and hopelessness within 40 minutes; no such improvements were observed in any of 7 saline controls.…”

Section: Other Relevant Studiesmentioning

confidence: 99%

Ketamine for Depression, 6: Effects on Suicidal Ideation and Possible Use as Crisis Intervention in Patients at Suicide Risk

Andrade

2018

J. Clin. Psychiatry

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A growing body of literature suggests that ketamine, administered in subanesthetic doses, has early-onset antidepressant action in patients with severe and even treatment-refractory depression. Many case reports, open-label studies, and randomized controlled trials (RCTs) suggest that ketamine may have dramatic antisuicidal effects, as well. This article examines the benefits of ketamine in patients with suicidal ideation with particular focus on the findings of recent RCTs and meta-analyses. Important findings are that a single dose of ketamine is associated with antisuicidal benefits that emerge within an hour of administration and persist for up to a week. The benefits are seen in patients with mild as well as clinically significant suicidal ideation. The benefits are observed in midazolam- as well as saline-controlled trials. Effect sizes are medium to large. The improvement in suicidal ideation is only partly explained by improvement in depression severity. It is concluded that there is consistent evidence that a single dose of ketamine has dramatic antisuicidal action that emerges almost immediately after dosing and persists for at least a week. The short- and intermediate-term safety and efficacy of ketamine as a crisis intervention treatment for suicidal patients merit study. Areas that need research are outlined.

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A Double-Blinded, Randomized, Placebo-Controlled Sub-Dissociative Dose Ketamine Pilot Study in the Treatment of Acute Depression and Suicidality in a Military Emergency Department Setting

Abstract: Despite methodology difficulties noted in this pilot study, there was statistical improvement in intervention group versus controls.

Cited by 54 publications

References 25 publications

Ketamine for acute suicidal ideation. An emergency department intervention: A randomized, double‐blind, placebo‐controlled, proof‐of‐concept trial

Ketamine for acute suicidal ideation. An emergency department intervention: A randomized, double‐blind, placebo‐controlled, proof‐of‐concept trial

A Review of Nonanesthetic Uses of Ketamine

Ketamine for Depression, 6: Effects on Suicidal Ideation and Possible Use as Crisis Intervention in Patients at Suicide Risk

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