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
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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