A Pilot Study of Ketamine Infusion after Suicide Attempt: New Frontiers in Treating Acute Suicidality in a Real-World Medical Setting
Abstract
:1. Introduction
2. Materials and Methods
3. Results
4. Discussion
4.1. Main Findings
4.2. Implications for Clinical Care and Resource Management for Suicidality
4.3. Comparison to Other Studies of Rapidly Acting Antidepressant and Anti-Suicide Agents
4.4. Patient Perspective
4.5. Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Franklin, J.C.; Ribeiro, J.D.; Fox, K.R.; Bentley, K.H.; Kleiman, E.M.; Huang, X.; Musacchio, K.M.; Jaroszewski, A.C.; Chang, B.P.; Nock, M.K. Risk factors for suicidal thoughts and behaviors: A meta-analysis of 50 years of research. Psychol. Bull. 2017, 143, 187–232. [Google Scholar] [CrossRef] [PubMed]
- World Health Organization. Suicide. Updated 17 June 2021. Available online: https://www.who.int/news-room/fact-sheets/detail/suicide (accessed on 3 October 2022).
- Centers for Disease Control and Prevention. Suicide Data and Statistics. Updated 28 June 2022. Available online: https://www.cdc.gov/suicide/suicide-data-statistics.html (accessed on 3 October 2022).
- Nock, M.K.; Borges, G.; Bromet, E.J.; Cha, C.B.; Kessler, R.C.; Lee, S. Suicide and suicidal behavior. Epidemiol. Rev. 2008, 30, 133–154. [Google Scholar] [CrossRef] [PubMed]
- O’Carroll, P.W.; Berman, A.L.; Maris, R.W.; Moscicki, E.K.; Tanney, B.L.; Silverman, M.M. Beyond the Tower of Babel: A nomenclature for suicidology. Suicide Life-Threat. Behav. 1996, 26, 237–252. [Google Scholar] [CrossRef] [PubMed]
- Silverman, M.M.; Berman, A.L.; Sanddal, N.D.; O’Carroll, P.W.; Joiner, T.E. Rebuilding the tower of Babel: A revised nomenclature for the study of suicide and suicidal behaviors. Part 1: Background, rationale, and methodology. Suicide Life-Threat. Behav. 2007, 37, 248–263. [Google Scholar] [CrossRef]
- Silverman, M.M.; Berman, A.L.; Sanddal, N.D.; O’Carroll, P.W.; Joiner, T.E. Rebuilding the tower of Babel: A revised nomenclature for the study of suicide and suicidal behaviors. Part 2: Suicide-related ideations, communications, and behaviors. Suicide Life-Threat. Behav. 2007, 37, 264–277. [Google Scholar] [CrossRef] [PubMed]
- Posner, K.; Oquendo, M.A.; Gould, M.; Stanley, B.; Davies, M. Columbia Classification Algorithm of Suicide Assessment (C-CASA): Classification of suicidal events in the FDA’s pediatric suicidal risk analysis of antidepressants. Am. J. Psychiatry 2007, 164, 1035–1043. [Google Scholar] [CrossRef] [PubMed]
- Watts, B.V.; Young-Xu, Y.; Mills, P.D.; DeRosier, J.M.; Kemp, J.; Shiner, B.; Duncan, W.E. Examination of the effectiveness of the Mental Health Environment of Care Checklist in reducing suicide on inpatient mental health units. Arch. Gen. Psychiatry 2012, 69, 588–592. [Google Scholar] [CrossRef] [Green Version]
- Qin, P.; Nordentoft, M. Suicide risk in relation to psychiatric hospitalization: Evidence based on longitudinal registers. Arch. Gen. Psychiatry 2005, 62, 427–432. [Google Scholar] [CrossRef] [PubMed]
- Griffiths, J.J.; Zarate, C.A., Jr.; Rasimas, J.J. Existing and novel biological therapeutics in suicide prevention. Am. J. Prev. Med. 2014, 47, S195–S203. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Long, D.; Long, B.; Koyfman, A. The emergency medicine management of severe alcohol withdrawal. Am. J. Emerg. Med. 2017, 35, 1005–1011. [Google Scholar] [CrossRef]
- Diazgranados, N.; Ibrahim, L.; Brutsche, N.E.; Ameli, R.; Henter, I.D.; Luckenbaugh, D.A.; Machado-Vieira, R.; Zarate, C.A., Jr. Rapid resolution of suicidal ideation after a single infusion of an NMDA antagonist in patients with treatment-resistant major depressive disorder. J. Clin. Psychiatry 2010, 71, 1605–1611. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Price, R.B.; Nock, M.K.; Charney, D.S.; Mathew, S.J. Effects of intravenous ketamine on explicit and implicit measures of suicidality in treatment-resistant depression. Biol. Psychiatry 2009, 66, 522–526. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Murrough, J.W.; Soleimani, L.; DeWilde, K.E.; Collins, K.A.; Lapidus, K.A.; Iacoviello, B.M.; Lener, M.; Kautz, M.; Kim, J.; Stern, J.B.; et al. Ketamine for rapid reduction of suicidal ideation: A randomized controlled trial. Psychol. Med. 2015, 45, 3571–3580. [Google Scholar] [CrossRef] [PubMed]
- Abdallah, C.G.; Sanacora, G.; Duman, R.S.; Krystal, J.H. Ketamine and rapid-acting antidepressants: A window into a new neurobiology for mood disorder therapeutics. Annu. Rev. Med. 2015, 66, 509–523. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Duman, R.S.; Aghajanian, G.K.; Sanacora, G.; Krystal, J.H. Synaptic plasticity and depression: New insights from stress and rapid-acting antidepressants. Nat. Med. 2016, 22, 238–249. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Zanos, P.; Moaddel, R.; Morris, P.J.; Georgiou, P.; Fischell, J.; Elmer, G.I.; Alkondon, M.; Yuan, P.; Pribut, H.J.; Singh, N.S.; et al. NMDAR inhibition-independent antidepressant actions of ketamine metabolites. Nature 2016, 533, 481–486. [Google Scholar] [CrossRef] [Green Version]
- Price, R.B.; Duman, R. Neuroplasticity in cognitive and psychological mechanisms of depression: An integrative model. Mol. Psychiatry 2020, 25, 530–543. [Google Scholar] [CrossRef]
- Kashdan, T.B.; Rottenberg, J. Psychological flexibility as a fundamental aspect of health. Clin. Psychol. Rev. 2010, 30, 865–878. [Google Scholar] [CrossRef] [Green Version]
- Ackerman, J.P.; McBee-Strayer, S.M.; Mendoza, K.; Stevens, J.; Sheftall, A.H.; Campo, J.V.; Bridge, J.A. Risk-sensitive decision-making deficit in adolescent suicide attempters. J. Child Adolesc. Psychopharmacol. 2015, 25, 109–113. [Google Scholar] [CrossRef] [Green Version]
- Keilp, J.G.; Beers, S.R.; Burke, A.K.; Melhem, N.M.; Oquendo, M.A.; Brent, D.A.; Mann, J.J. Neuropsychological deficits in past suicide attempters with varying levels of depression severity. Psychol. Med. 2014, 44, 2965–2974. [Google Scholar] [CrossRef]
- Keilp, J.G.; Gorlyn, M.; Russell, M.; Oquendo, M.A.; Burke, A.K.; Harkavy-Friedman, J.; Mann, J.J. Neuropsychological function and suicidal behavior: Attention control, memory and executive dysfunction in suicide attempt. Psychol. Med. 2013, 43, 539–551. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Keilp, J.G.; Sackeim, H.A.; Brodsky, B.S.; Oquendo, M.A.; Malone, K.M.; Mann, J.J. Neuropsychological dysfunction in depressed suicide attempters. Am. J. Psychiatry 2001, 158, 735–741. [Google Scholar] [CrossRef] [PubMed]
- Jollant, F.; Bellivier, F.; Leboyer, M.; Astruc, B.; Torres, S.; Verdier, R.; Castelnau, D.; Malafosse, A.; Courtet, P. Impaired decision making in suicide attempters. Am. J. Psychiatry 2005, 162, 304–310. [Google Scholar] [CrossRef] [PubMed]
- Disner, S.G.; Beevers, C.G.; Haigh, E.A.; Beck, A.T. Neural mechanisms of the cognitive model of depression. Nat. Rev. Neurosci. 2011, 12, 467–477. [Google Scholar] [CrossRef]
- Nock, M.K.; Park, J.M.; Finn, C.T.; Deliberto, T.L.; Dour, H.J.; Banaji, M.R. Measuring the suicidal mind: Implicit cognition predicts suicidal behavior. Psychol. Sci. 2010, 21, 511–517. [Google Scholar] [CrossRef] [Green Version]
- Nock, M.K.; Banaji, M.R. Prediction of suicide ideation and attempts among adolescents using a brief performance-based test. J. Consult. Clin. Psychol. 2007, 75, 707–715. [Google Scholar] [CrossRef] [Green Version]
- Cha, C.B.; O’Connor, R.C.; Kirtley, O.; Cleare, S.; Wetherall, K.; Eschle, S.; Tezanos, K.M.; Nock, M.K. Testing mood-activated psychological markers for suicidal ideation. J. Abnorm. Psychol. 2018, 127, 448–457. [Google Scholar] [CrossRef] [Green Version]
- Domany, Y.; Shelton, R.C.; McCullumsmith, C.B. Ketamine for acute suicidal ideation. An emergency department intervention: A randomized, double-blind, placebo-controlled, proof-of-concept trial. Depress. Anxiety 2020, 37, 224–233. [Google Scholar] [CrossRef]
- Domany, Y.; McCullumsmith, C.B. 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. Arch. Suicide Res. 2021, 26, 1250–1265. [Google Scholar] [CrossRef]
- Weisz, J.R.; Chu, B.C.; Polo, A.J. Treatment dissemination and evidence-based practice: Strengthening intervention through clinician-researcher collaboration. Clin. Psychol. Sci. Pract. 2004, 11, 300–307. [Google Scholar] [CrossRef]
- Dakwar, E.; Levin, F.R.; Hart, C.L.; Basaraba, C.N.; Choi, C.J.; Pavlicova, M.; Nunes, E.V. A single ketamine infusion combined with motivational enhancement therapy for alcohol use disorder: A randomized, midazolam-controlled pilot trial. Am. J. Psychiatry 2020, 177, 125–133. [Google Scholar] [CrossRef] [PubMed]
- Dakwar, E.; Nunes, E.V.; Hart, C.L.; Foltin, R.W.; Mathew, S.J.; Carpenter, K.M.; Choi, C.J.J.; Basaraba, C.N.; Pavlicova, M.; Levin, F.R. A Single Ketamine Infusion Combined With Mindfulness-Based Behavioral Modification to Treat Cocaine Dependence: A Randomized Clinical Trial. Am. J. Psychiatry 2019, 176, 923–930. [Google Scholar] [CrossRef] [PubMed]
- Wilkinson, S.T.; Wright, D.; Fasula, M.K.; Fenton, L.; Griepp, M.; Ostroff, R.B.; Sanacora, G. Cognitive Behavior Therapy May Sustain Antidepressant Effects of Intravenous Ketamine in Treatment-Resistant Depression. Psychother. Psychosom. 2017, 86, 162–167. [Google Scholar] [CrossRef] [Green Version]
- Pradhan, B.; Mitrev, L.; Moaddell, R.; Wainer, I.W. d-Serine is a potential biomarker for clinical response in treatment of post-traumatic stress disorder using (R,S)-ketamine infusion and TIMBER psychotherapy: A pilot study. Biochim. Biophys. Acta Proteins Proteom. 2018, 1866, 831–839. [Google Scholar] [CrossRef] [PubMed]
- Shiroma, P.R.; Thuras, P.; Wels, J.; Erbes, C.; Kehle-Forbes, S.; Polusny, M. A Proof-of-Concept Study of Subanesthetic Intravenous Ketamine Combined With Prolonged Exposure Therapy Among Veterans With Posttraumatic Stress Disorder. J. Clin. Psychiatry 2020, 81, 10118. [Google Scholar] [CrossRef]
- Rodriguez, C.I.; Wheaton, M.; Zwerling, J.; Steinman, S.A.; Sonnenfeld, D.; Galfalvy, H.; Blair Simpson, H. Can exposure-based CBT extend the effects of intravenous ketamine in obsessive-compulsive disorder? An open-label trial. J. Clin. Psychiatry 2016, 77, 408–409. [Google Scholar] [CrossRef] [Green Version]
- Wilkinson, S.; Holtzheimer, P.E.; Gao, S.; Kirwin, D.; Price, R. Leveraging neuroplasticity to enhance adaptive learning: The potential for synergistic somatic-behavioral treatment combinations to improve clinical outcomes in depression. Biol. Psychiatry 2019, 85, 454–465. [Google Scholar] [CrossRef]
- Ashendorf, L.; Jefferson, A.L.; Green, R.C.; Stern, R.A. Test-retest stability on the WRAT-3 reading subtest in geriatric cognitive evaluations. J. Clin. Exp. Neuropsychol. 2009, 31, 605–610. [Google Scholar] [CrossRef] [Green Version]
- Sheehan, D.V.; Lecrubier, Y.; Sheehan, K.H.; Amorim, P.; Janavs, J.; Weiller, E.; Hergueta, T.; Baker, R.; Dunbar, G.C. The Mini-International Neuropsychiatric Interview (M.I.N.I.): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J. Clin. Psychiatry 1998, 59 (Suppl. S20), 22–33. [Google Scholar]
- Herniman, S.E.; Cotton, S.M.; Allott, K.A.; Phillips, L.J.; Wood, S.J. The psychometric validity of the Montgomery-Åsberg Depression Rating Scale (MADRS) in recent onset schizophrenia spectrum disorders. Schizophr. Res. 2021, 228, 373–381. [Google Scholar] [CrossRef]
- Beck, A.T.; Steer, R.A. Manual for the Beck Scale for Suicide Ideation; Psychological Corporation: San Antonio, TX, USA, 1991. [Google Scholar]
- Posner, K.; Brown, G.K.; Stanley, B.; Brent, D.A.; Yershova, K.V.; Oquendo, M.A.; Currier, G.W.; Melvin, G.A.; Greenhill, L.; Shen, S.; et al. The Columbia-Suicide Severity Rating Scale: Initial validity and internal consistency findings from three multisite studies with adolescents and adults. Am. J. Psychiatry 2011, 168, 1266–1277. [Google Scholar] [CrossRef] [PubMed]
- Reynolds, W.M. Psychometric characteristics of the Adult Suicidal Ideation Questionnaire in college students. J. Pers. Assess. 1991, 56, 289–307. [Google Scholar] [CrossRef] [PubMed]
- Rush, A.J.; Trivedi, M.H.; Ibrahim, H.M.; Carmody, T.J.; Arnow, B.; Klein, D.N.; Markowitz, J.C.; Ninan, P.T.; Kornstein, S.; Manber, R.; et al. The 16-Item Quick Inventory of Depressive Symptomatology (QIDS), Clinician Rating (QIDS-C) and Self-Report (QIDS-SR): A Psychometric evaluation in patients with chronic major depression. Biol. Psychiatry 2003, 54, 573–583. [Google Scholar] [CrossRef]
- Wilkinson, G.S. The Wide Range Achievement Test: Manual, 3rd ed.; Wide Range: Wilmington, DE, USA, 1993. [Google Scholar]
- Irigoyen, M.; Porras-Segovia, A.; Galvan, L.; Puigdevall, M.; Giner, L.; De Leon, S.; Baca-Garcia, E. Predictors of re-attempt in a cohort of suicide attempters: A survival analysis. J. Affect. Disord. 2019, 247, 20–28. [Google Scholar] [CrossRef] [PubMed]
- Parra-Uribe, I.; Blasco-Fontecilla, H.; Garcia-Pares, G.; Martinez-Naval, L.; Valero-Coppin, O.; Cebria-Meca, A.; Oquendo, M.A.; Palao-Vidal, D. Risk of re-attempts and suicide death after a suicide attempt: A survival analysis. BMC Psychiatry 2017, 17, 163. [Google Scholar] [CrossRef] [Green Version]
- Yim, P.H.; Yip, P.S.; Li, R.H.; Dunn, E.L.; Yeung, W.S.; Miao, Y.K. Suicide after discharge from psychiatric inpatient care: A case-control study in Hong Kong. Aust. N. Z. J. Psychiatry 2004, 38, 65–72. [Google Scholar] [CrossRef]
- Mann, J.J. Neurobiology of suicidal behaviour. Nat. Rev. Neurosci. 2003, 4, 819–828. [Google Scholar] [CrossRef]
- Gvion, Y.; Levi-Belz, Y. Serious Suicide Attempts: Systematic Review of Psychological Risk Factors. Front. Psychiatry 2018, 9, 56. [Google Scholar] [CrossRef] [Green Version]
- CDC. WISQARS™—Web-based Injury Statistics Query and Reporting System. Centers for Disease Control and Prevention. 2020. Available online: https://www.cdc.gov/injury/wisqars/index.html (accessed on 3 October 2022).
- Egede, L.E.; Ruggiero, K.J.; Frueh, B.C. Ensuring mental health access for vulnerable populations in COVID era. J. Psychiatr. Res. 2020, 129, 147–148. [Google Scholar] [CrossRef]
- Pinals, D.A.; Fuller, D.A. The Vital Role of a Full Continuum of Psychiatric Care Beyond Beds. Psychiatr. Serv. 2020, 71, 713–721. [Google Scholar] [CrossRef]
- Kraft, C.M.; Morea, P.; Teresi, B.; Platts-Mills, T.F.; Blazer, N.L.; Brice, J.H.; Strain, A.K. Characteristics, clinical care, and disposition barriers for mental health patients boarding in the emergency department. Am. J. Emerg. Med. 2021, 46, 550–555. [Google Scholar] [CrossRef] [PubMed]
- Smith, J.L.; De Nadai, A.S.; Storch, E.A.; Langland-Orban, B.; Pracht, E.; Petrila, J. Correlates of Length of Stay and Boarding in Florida Emergency Departments for Patients With Psychiatric Diagnoses. Psychiatr. Serv. 2016, 67, 1169–1174. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Paris, J. Is hospitalization useful for suicidal patients with borderline personality disorder? J. Pers. Disord. 2004, 18, 240–247. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Paris, J. Chronic suicidality among patients with borderline personality disorder. Psychiatr. Serv. 2002, 53, 738–742. [Google Scholar] [CrossRef]
- Barbosa, M.G.; Delfino, R.S.; Sarin, L.M.; Jackowski, A.P. Repeated subcutaneous esketamine administration for depressive symptoms and pain relief in a terminally ill cancer patient: A case report. Palliat. Med. 2020, 34, 822–825. [Google Scholar] [CrossRef] [PubMed]
- Scuteri, D.; Corasaniti, M.T.; Tonin, P.; Nicotera, P.; Bagetta, G. New trends in pharmacological control of neuropsychiatric symptoms of dementia. Curr. Opin. Pharmacol. 2021, 61, 69–76. [Google Scholar] [CrossRef]
- Treu, C.N.; Groth, C.M.; Patel, J.H. The Use of Continuous Ketamine for Analgesia and Sedation in Critically Ill Patients with Opioid Abuse: A Case Series. J. Crit. Care Med. 2017, 3, 148–152. [Google Scholar] [CrossRef] [Green Version]
- Yovell, Y.; Bar, G.; Mashiah, M.; Baruch, Y.; Briskman, I.; Asherov, J.; Lotan, A.; Rigbi, A.; Panksepp, J. Ultra-Low-Dose Buprenorphine as a Time-Limited Treatment for Severe Suicidal Ideation: A Randomized Controlled Trial. Am. J. Psychiatry 2016, 173, 491–498. [Google Scholar] [CrossRef] [Green Version]
- Meltzer-Brody, S.; Colquhoun, H.; Riesenberg, R.; Epperson, C.N.; Deligiannidis, K.M.; Rubinow, D.R.; Li, H.; Sankoh, A.J.; Clemson, C.; Schacterle, A.; et al. Brexanolone injection in post-partum depression: Two multicentre, double-blind, randomised, placebo-controlled, phase 3 trials. Lancet 2018, 392, 1058–1070. [Google Scholar] [CrossRef]
- Faden, J.; Citrome, L. Intravenous brexanolone for postpartum depression: What it is, how well does it work, and will it be used? Ther. Adv. Psychopharmacol. 2020, 10, 2045125320968658. [Google Scholar] [CrossRef]
- Deligiannidis, K.M.; Meltzer-Brody, S.; Gunduz-Bruce, H.; Doherty, J.; Jonas, J.; Li, S.; Sankoh, A.J.; Silber, C.; Campbell, A.D.; Werneburg, B.; et al. Effect of Zuranolone vs Placebo in Postpartum Depression: A Randomized Clinical Trial. JAMA Psychiatry 2021, 78, 951–959. [Google Scholar] [CrossRef] [PubMed]
- Gunduz-Bruce, H.; Silber, C.; Kaul, I.; Rothschild, A.J.; Riesenberg, R.; Sankoh, A.J.; Li, H.; Lasser, R.; Zorumski, C.F.; Rubinow, D.R.; et al. Trial of SAGE-217 in Patients with Major Depressive Disorder. N. Engl. J. Med. 2019, 381, 903–911. [Google Scholar] [CrossRef] [PubMed]
- Bullock, A.; Kaul, I.; Li, S.; Silber, C.; Doherty, J.; Kanes, S.J. Zuranolone as an oral adjunct to treatment of Parkinsonian tremor: A phase 2, open-label study. J. Neurol. Sci. 2021, 421, 117277. [Google Scholar] [CrossRef] [PubMed]
- Bullock, A.; Gunduz-Bruce, H.; Zammit, G.K.; Qin, M.; Li, H.; Sankoh, A.J.; Silber, C.; Kanes, S.J.; Jonas, J.; Doherty, J. A phase 1 double-blind, placebo-controlled study of zuranolone (SAGE-217) in a phase advance model of insomnia in healthy adults. Hum. Psychopharmacol. 2021, 37, e2806. [Google Scholar] [CrossRef] [PubMed]
- Can, A.T.; Hermens, D.F.; Dutton, M.; Gallay, C.C.; Jensen, E.; Jones, M.; Scherman, J.; Beaudequin, D.A.; Yang, C.; Schwenn, P.E.; et al. Low dose oral ketamine treatment in chronic suicidality: An open-label pilot study. Transl. Psychiatry 2021, 11, 101. [Google Scholar] [CrossRef]
- Schatzberg, A.F. A Word to the Wise About Intranasal Esketamine. Am. J. Psychiatry 2019, 176, 422–424. [Google Scholar] [CrossRef] [Green Version]
- Schatzberg, A.F. A word to the wise about ketamine. Am. J. Psychiatry 2014, 171, 262–264. [Google Scholar] [CrossRef] [PubMed]
- Phillips, J.L.; Norris, S.; Talbot, J.; Hatchard, T.; Ortiz, A.; Birmingham, M.; Owoeye, O.; Batten, L.A.; Blier, P. Single and repeated ketamine infusions for reduction of suicidal ideation in treatment-resistant depression. Neuropsychopharmacology 2020, 45, 606–612. [Google Scholar] [CrossRef] [PubMed]
- Conner, K.R.; Kearns, J.C.; Esposito, E.C.; Pizzarello, E.; Wiegand, T.J.; Britton, P.C.; Michel, K.; Gysin-Maillart, A.C.; Goldston, D.B. Pilot RCT of the Attempted Suicide Short Intervention Program (ASSIP) adapted for rapid delivery during hospitalization to adult suicide attempt patients with substance use problems. Gen. Hosp. Psychiatry 2021, 72, 66–72. [Google Scholar] [CrossRef] [PubMed]
- Borges, G.; Bagge, C.L.; Cherpitel, C.J.; Conner, K.R.; Orozco, R.; Rossow, I. A meta-analysis of acute use of alcohol and the risk of suicide attempt. Psychol. Med. 2017, 47, 949–957. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Prince, J. Substance Use Disorder and Suicide Attempt Among People Who Report Compromised Health. Subst. Use Misus 2018, 53, 9–15. [Google Scholar] [CrossRef] [PubMed]
- Yuodelis-Flores, C.; Ries, R.K. Addiction and suicide: A review. Am. J. Addict. 2015, 24, 98–104. [Google Scholar] [CrossRef] [PubMed]
- Abbar, M.; Demattei, C.; El-Hage, W.; Llorca, P.M.; Samalin, L.; Demaricourt, P.; Gaillard, R.; Courtet, P.; Vaiva, G.; Gorwood, P.; et al. Ketamine for the acute treatment of severe suicidal ideation: Double blind, randomised placebo controlled trial. BMJ 2022, 376, e067194. [Google Scholar] [CrossRef] [PubMed]
Ketamine-Treated Sample (n = 16) | Case-Control Sample (n = 16) | |||
---|---|---|---|---|
Race, n (%) | ||||
White | 13 | (81.3%) | 13 | (81.3%) |
Black | 3 | (18.8%) | 2 | (12.5%) |
Unknown | -- | 1 | (6.3%) | |
Gender, n (%) | ||||
Female | 8 | (50%) | 8 | (50%) |
Male | 7 | (43.8%) | 7 | (43.8%) |
Transgender (female-to-male) | 1 | (6.3%) | 1 | (6.3%) |
Age, mean (SD) | 34.06 | (16.06) | 35.56 | (16.46) |
Taking psychotropic medication at time of index SA, n (%) | 15 | (93.8%) | 14 | (87.5%) |
Number of psychotropic medications, mean (SD) | 2.67 | (1.59) | 2.64 | (1.39) |
Principal diagnoses, n (%) ¥ | ||||
Unipolar | ||||
Major Depressive Disorder | 5 | (31.3%) | 2 | (12.5%) |
Major Depressive Disorder w/Psychotic Features | 2 | (12.5%) | 0 | (0%) |
Depressive Disorder NOS | 2 | (12.5%) | 7 | (43.8%) |
Bipolar | ||||
Bipolar I Disorder | 4 | (25%) | 2 | (12.5%) |
Bipolar I Disorder w/Psychotic Features | 1 | (6.3%) | 1 | (6.3%) |
Bipolar II Disorder | 2 | (12.5%) | 2 | (12.5%) |
Other Bipolar and Related | 0 | (0%) | 2 | (12.5%) |
Comorbid alcohol- or substance-use disorder, n (%) | 5 | (31.3%) | 2 | (12.5%) |
Symptom | Frequency (n) | % (of 16 Patients) |
---|---|---|
Anxiety | 5 | 31.25 |
Constipation | 4 | 25.00 |
Decreased energy | 3 | 18.75 |
Diarrhea | 1 | 6.25 |
Difficulty sleeping: too little | 6 | 37.50 |
Difficulty sleeping: too much | 1 | 6.25 |
Dizziness | 4 | 25.00 |
Dry mouth | 2 | 12.50 |
Emotional indifference | 5 | 31.25 |
Feeling ‘high’ | 1 | 6.25 |
Headache | 5 | 31.25 |
Increased appetite | 3 | 18.75 |
Loss of sexual desire | 1 | 6.25 |
Nausea | 3 | 18.75 |
Restlessness | 3 | 18.75 |
Sweating | 5 | 31.25 |
Tremors | 1 | 6.25 |
Trouble achieving orgasm | 1 | 6.25 |
Measure | Baseline (n = 16) | Day 1 | Day 1 Statistics | Day 5 | Day 5 Statistics | Day 12 | Day 12 Statistics | Month 1 | Month 1 Statistics | Month 3 | Month 3 Statistics | Month 6 | Month 6 Statistics |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
MADRS total | 37.75 (6.2) | 16.75 (9.71) | n = 16, t15 = 11.3, p < 0.001, d = 2.6 [1.6,3.4] | 17.53 (9.28) | n = 15, t14 = 8.7, p < 0.001, d = 2.5 [1.5,3.4] | 16.20 (11.91) | n = 10, t9 = 5.5, p < 0.001, d = 2.4 [1.2,3.4] | 16.22 (11.72) | n = 9, t8 = 6.6, p < 0.001, d = 2.3 [1.0,3.3] | 14.09 (10.90) | n = 11, t10 = 8.8, p < 0.001, d = 2.8 [1.5,3.8] | 15.67 (11.68) | n = 12, t11 = 7.0, p < 0.001, d = 2.4 [1.2,3.3] |
MADRS-SI | 5.94 (0.25) | 0.81 (1.22) | n = 16, t15 = 17.0, p < 0.001, d = 5.8 [4.1,7.3] | 0.80 (1.32) | n = 15, t14 = 15.3, p < 0.001, d = 5.4 [3.7,6.8] | 0.50 (1.27) | n = 10, t9 = 13.7, p < 0.001, d = 6.1 [3.9,7.9] | 1.11 (1.76) | n = 9, t8 = 8.3, p < 0.001, d = 3.9 [2.2,5.3] | 1.18 (1.83) | n = 11, t10 = 8.7, p < 0.001, d = 3.7 [2.2,4.9] | 1.08 (1.68) | n = 12, t11 = 10.2, p < 0.001, d = 4.0 [2.5,5.3] |
CSSRS-SI | 4.94 (0.25) | 0.38 (0.72) | n = 16, t15= 20.5, p < 0.001, d = 8.5 [6.1,10.4] | 0.47 (0.99) | n = 15, t14 = 15.4, p < 0.001, d = 6.2 [4.3,7.7] | 0.30 (0.95) | n = 10, t9 = 15.7, p < 0.001, d = 7.0 [4.5,9.0] | 0.78 (1.39) | n = 9, t8 = 9.1, p < 0.001, d = 4.3 [2.5,5.7] | 1.36 (1.96) | n = 11, t10 = 6.0, p < 0.001, d = 2.4 [1.3,3.5] | 0.92 (1.62) | n = 12, t11 = 8.7, p < 0.001, d = 3.6 [2.2,4.7] |
ASIQ | 91.93 (32.29) | 38.20 (30.00) | n = 15, t14 = 6.9, p < 0.001, d = 1.7 [0.9,2.5] | 23.07 (8.46) | n = 14, t13 = 8.2, p < 0.001, d = 2.8 [1.7,3.8] | 27.17 (27.17) | n = 12, t11 = 5.9, p < 0.001, d = 2.0 [0.9,2.8] | 36.90 (38.43) | n = 10, t9 = 4.8, p = 0.001, d = 1.6 [0.5,2.5] | 35.10 (37.79) | n = 10, t9= 4.8, p = 0.001, d = 1.7 [0.6,2.6] | 43.00 (49.86) | n = 7, t6 = 4.1, p = 0.006, d = 1.0 [−0.2,2.1] ¥ |
SSI | 29.29 (1.50) | 3.00 (6.27) | n = 7, t6 = 9.6, p < 0.001, d = 5.8 [3.1,7.6] | 4.86 (8.25) | n = 7, t6 = 7.7, p < 0.001, d = 4.1 [2.1,5.6] | 4.50 (9.00) | n = 4, t3 = 5.1, p = 0.014, d = 3.8 [1.2,5.4] | 6.75 (7.23) | n = 4, t3 = 6.9, p = 0.006, d = 4.3 [1.4,6.0] | 6.38 (8.70) | n = 8, t7 = 7.3, p < 0.001, d = 3.6 [1.9,5.0] | 7.50 (10.56) | n = 10, t9 = 6.6, p < 0.001, d = 2.9 [1.6,4.1] |
QIDS-SR | 15.9 (5.1) | 11.9 (10.6) | n = 14, t13 = 2.8, p = 0.015, d = 0.76 [−0.03,1.5] ¥ | 8.15 (4.76) | n = 13, t12 = 4.3, p < 0.001, d = 1.49 [0.6,2.3] | 7.55 (6.2) | n = 11, t10 = 4.1, p = 0.002, d = 1.47 [0.5,2.3] | 9.00 (5.68) | n = 9, t8 = 3.2, p = 0.013, d = 1.20 [0.2,2.1] | 11.56 (6.40) | n = 9, t8 = 2.2, p = 0.06, d = 0.70 [−0.3,1.6] | 12.14 (3.74) | n = 7, t6 = 1.19, p = 0.28, d = 0.48 [−0.6,1.5] |
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Shivanekar, S.; Gopalan, P.; Pizon, A.; Spotts, C.; Cruz, N.; Lightfoot, M.; Rohac, R.; Baumeister, A.; Griffo, A.; Panny, B.; et al. A Pilot Study of Ketamine Infusion after Suicide Attempt: New Frontiers in Treating Acute Suicidality in a Real-World Medical Setting. Int. J. Environ. Res. Public Health 2022, 19, 13792. https://doi.org/10.3390/ijerph192113792
Shivanekar S, Gopalan P, Pizon A, Spotts C, Cruz N, Lightfoot M, Rohac R, Baumeister A, Griffo A, Panny B, et al. A Pilot Study of Ketamine Infusion after Suicide Attempt: New Frontiers in Treating Acute Suicidality in a Real-World Medical Setting. International Journal of Environmental Research and Public Health. 2022; 19(21):13792. https://doi.org/10.3390/ijerph192113792
Chicago/Turabian StyleShivanekar, Sharvari, Priya Gopalan, Anthony Pizon, Crystal Spotts, Nicolas Cruz, Michael Lightfoot, Rebecca Rohac, Andrew Baumeister, Angela Griffo, Benjamin Panny, and et al. 2022. "A Pilot Study of Ketamine Infusion after Suicide Attempt: New Frontiers in Treating Acute Suicidality in a Real-World Medical Setting" International Journal of Environmental Research and Public Health 19, no. 21: 13792. https://doi.org/10.3390/ijerph192113792
APA StyleShivanekar, S., Gopalan, P., Pizon, A., Spotts, C., Cruz, N., Lightfoot, M., Rohac, R., Baumeister, A., Griffo, A., Panny, B., Kucherer, S., Israel, A., Rengasamy, M., & Price, R. (2022). A Pilot Study of Ketamine Infusion after Suicide Attempt: New Frontiers in Treating Acute Suicidality in a Real-World Medical Setting. International Journal of Environmental Research and Public Health, 19(21), 13792. https://doi.org/10.3390/ijerph192113792