Ketamine Alleviates Suicidal Thoughts Better Than Midazolam

Adjunctive ketamine is associated with a greater 24-hour reduction in suicidal ideation vs midazolam in patients with major depressive disorder (MDD), according to a recent study.

Although ketamine has been shown to rapidly reduce suicidal thoughts in patients with low levels of suicidal ideation, less data currently exists on its effectiveness for clinically significant suicidal ideation among patients with MDD.
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For their study, the researchers assessed 80 adults with current MDD and a score of at least 4 on the Scale for Suicidal Ideation (SSI). Of these patients, 43 (54%) were on antidepressant medication. Patients were randomly assigned to receive either ketamine or midazolam infusion.

SSI score 24 hours after infusion served as the primary outcome measure. Response was defined as having a reduction of at least 50% in SSI score.

Results of the study showed that patients on ketamine had a 4.96 greater reduction in SSI score at day 1 vs patients on midazolam. Approximately 55% of patients in the ketamine group demonstrated response to the study drug vs 30% in the midazolam group.

In addition, patients on ketamine demonstrated a greater improvement in the Profile of Mood States depression subscale compared with those on midazolam. This effect mediated 33.6% of the effect of ketamine on SSI scores, the researchers noted.

Any side effects that occurred were brief. In addition, in an uncontrolled follow-up, clinical improvement was maintained for as long as 6 weeks with additional optimized standard pharmacotherapy.

“Adjunctive ketamine demonstrated a greater reduction in clinically significant suicidal ideation in depressed patients within 24 hours compared with midazolam, partially independently of antidepressant effect,” the researchers concluded.

—Christina Vogt

Reference:

Grunebaum MF, Galfalvy HC, Choo TH, et al. Ketamine for rapid reduction of suicidal thoughts in major depression: a midazolam-controlled randomized clinical trial [Published online December 2017]. Am J Psychiatry. https://doi.org/10.1176/appi.ajp.2017.17060647.