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

Elizabeth D. Ballard, Dawn F. Ionescu, Jennifer Vande Voort, Mark J. Niciu, Erica M. Richards, David A. Luckenbaugh, Nancy E. Brutsché, Rezvan Ameli, Maura L. Furey, Carlos A. Zarate

Research output: Contribution to journalArticle

102 Citations (Scopus)

Abstract

Objective: Suicide is a psychiatric emergency. Currently, there are no approved pharmacologic treatments for suicidal ideation. Ketamine is an N-methyl-D-aspartate (NMDA) receptor antagonist that rapidly reduces suicidal ideation as well as depression and anxiety, but the dynamic between these symptoms is not known. The aim of this analysis was to evaluate whether ketamine has an impact on suicidal thoughts, independent of depressive and anxiety symptoms. Methods: 133 patients with treatment-resistant depression (major depressive disorder or bipolar I/II disorder) received a single subanesthetic infusion of ketamine (0.5mg/kg over 40min). Post-hoc correlations and linear mixed models evaluated the relationship between suicidal ideation and depression and anxiety symptoms using the Hamilton Depression Rating Scale (HAMD), Scale for Suicidal Ideation (SSI), Beck Depression Inventory (BDI), and Hamilton Anxiety Rating Scale (HAMA) focusing on 230min post-infusion. Results: At 230min post-infusion, correlations between changes in suicidal ideation and depression ranged from 0.23 to 0.44 (p<.05), accounting for up to 19% in the variance of ideation change. Correlations with anxiety ranged from 0.23 to 0.40 (p<.05), accounting for similar levels of variance. Ketamine infusion was associated with significant reductions in suicidal ideation compared to placebo, when controlling for the effects of ketamine on depression (F1,587=10.31, p=001) and anxiety (F1,567=8.54, p=004). Conclusions: Improvements in suicidal ideation after ketamine infusion are related to, but not completely driven by, improvements in depression and anxiety. Investigation of the specific effects of ketamine on suicidal thoughts is warranted.

Original languageEnglish (US)
Pages (from-to)161-166
Number of pages6
JournalJournal of Psychiatric Research
Volume58
DOIs
StatePublished - Nov 1 2014
Externally publishedYes

Fingerprint

Suicidal Ideation
Ketamine
Anxiety
Depression
Treatment-Resistant Depressive Disorder
Major Depressive Disorder
N-Methyl-D-Aspartate Receptors
Suicide
Psychiatry
Linear Models
Emergencies
Placebos
Equipment and Supplies

Keywords

  • Depression
  • Ketamine
  • Suicidal ideation
  • Suicide

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Biological Psychiatry

Cite this

Improvement in suicidal ideation after ketamine infusion : Relationship to reductions in depression and anxiety. / Ballard, Elizabeth D.; Ionescu, Dawn F.; Vande Voort, Jennifer; Niciu, Mark J.; Richards, Erica M.; Luckenbaugh, David A.; Brutsché, Nancy E.; Ameli, Rezvan; Furey, Maura L.; Zarate, Carlos A.

In: Journal of Psychiatric Research, Vol. 58, 01.11.2014, p. 161-166.

Research output: Contribution to journalArticle

Ballard, ED, Ionescu, DF, Vande Voort, J, Niciu, MJ, Richards, EM, Luckenbaugh, DA, Brutsché, NE, Ameli, R, Furey, ML & Zarate, CA 2014, 'Improvement in suicidal ideation after ketamine infusion: Relationship to reductions in depression and anxiety', Journal of Psychiatric Research, vol. 58, pp. 161-166. https://doi.org/10.1016/j.jpsychires.2014.07.027
Ballard, Elizabeth D. ; Ionescu, Dawn F. ; Vande Voort, Jennifer ; Niciu, Mark J. ; Richards, Erica M. ; Luckenbaugh, David A. ; Brutsché, Nancy E. ; Ameli, Rezvan ; Furey, Maura L. ; Zarate, Carlos A. / Improvement in suicidal ideation after ketamine infusion : Relationship to reductions in depression and anxiety. In: Journal of Psychiatric Research. 2014 ; Vol. 58. pp. 161-166.
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abstract = "Objective: Suicide is a psychiatric emergency. Currently, there are no approved pharmacologic treatments for suicidal ideation. Ketamine is an N-methyl-D-aspartate (NMDA) receptor antagonist that rapidly reduces suicidal ideation as well as depression and anxiety, but the dynamic between these symptoms is not known. The aim of this analysis was to evaluate whether ketamine has an impact on suicidal thoughts, independent of depressive and anxiety symptoms. Methods: 133 patients with treatment-resistant depression (major depressive disorder or bipolar I/II disorder) received a single subanesthetic infusion of ketamine (0.5mg/kg over 40min). Post-hoc correlations and linear mixed models evaluated the relationship between suicidal ideation and depression and anxiety symptoms using the Hamilton Depression Rating Scale (HAMD), Scale for Suicidal Ideation (SSI), Beck Depression Inventory (BDI), and Hamilton Anxiety Rating Scale (HAMA) focusing on 230min post-infusion. Results: At 230min post-infusion, correlations between changes in suicidal ideation and depression ranged from 0.23 to 0.44 (p<.05), accounting for up to 19{\%} in the variance of ideation change. Correlations with anxiety ranged from 0.23 to 0.40 (p<.05), accounting for similar levels of variance. Ketamine infusion was associated with significant reductions in suicidal ideation compared to placebo, when controlling for the effects of ketamine on depression (F1,587=10.31, p=001) and anxiety (F1,567=8.54, p=004). Conclusions: Improvements in suicidal ideation after ketamine infusion are related to, but not completely driven by, improvements in depression and anxiety. Investigation of the specific effects of ketamine on suicidal thoughts is warranted.",
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T1 - Improvement in suicidal ideation after ketamine infusion

T2 - Relationship to reductions in depression and anxiety

AU - Ballard, Elizabeth D.

AU - Ionescu, Dawn F.

AU - Vande Voort, Jennifer

AU - Niciu, Mark J.

AU - Richards, Erica M.

AU - Luckenbaugh, David A.

AU - Brutsché, Nancy E.

AU - Ameli, Rezvan

AU - Furey, Maura L.

AU - Zarate, Carlos A.

PY - 2014/11/1

Y1 - 2014/11/1

N2 - Objective: Suicide is a psychiatric emergency. Currently, there are no approved pharmacologic treatments for suicidal ideation. Ketamine is an N-methyl-D-aspartate (NMDA) receptor antagonist that rapidly reduces suicidal ideation as well as depression and anxiety, but the dynamic between these symptoms is not known. The aim of this analysis was to evaluate whether ketamine has an impact on suicidal thoughts, independent of depressive and anxiety symptoms. Methods: 133 patients with treatment-resistant depression (major depressive disorder or bipolar I/II disorder) received a single subanesthetic infusion of ketamine (0.5mg/kg over 40min). Post-hoc correlations and linear mixed models evaluated the relationship between suicidal ideation and depression and anxiety symptoms using the Hamilton Depression Rating Scale (HAMD), Scale for Suicidal Ideation (SSI), Beck Depression Inventory (BDI), and Hamilton Anxiety Rating Scale (HAMA) focusing on 230min post-infusion. Results: At 230min post-infusion, correlations between changes in suicidal ideation and depression ranged from 0.23 to 0.44 (p<.05), accounting for up to 19% in the variance of ideation change. Correlations with anxiety ranged from 0.23 to 0.40 (p<.05), accounting for similar levels of variance. Ketamine infusion was associated with significant reductions in suicidal ideation compared to placebo, when controlling for the effects of ketamine on depression (F1,587=10.31, p=001) and anxiety (F1,567=8.54, p=004). Conclusions: Improvements in suicidal ideation after ketamine infusion are related to, but not completely driven by, improvements in depression and anxiety. Investigation of the specific effects of ketamine on suicidal thoughts is warranted.

AB - Objective: Suicide is a psychiatric emergency. Currently, there are no approved pharmacologic treatments for suicidal ideation. Ketamine is an N-methyl-D-aspartate (NMDA) receptor antagonist that rapidly reduces suicidal ideation as well as depression and anxiety, but the dynamic between these symptoms is not known. The aim of this analysis was to evaluate whether ketamine has an impact on suicidal thoughts, independent of depressive and anxiety symptoms. Methods: 133 patients with treatment-resistant depression (major depressive disorder or bipolar I/II disorder) received a single subanesthetic infusion of ketamine (0.5mg/kg over 40min). Post-hoc correlations and linear mixed models evaluated the relationship between suicidal ideation and depression and anxiety symptoms using the Hamilton Depression Rating Scale (HAMD), Scale for Suicidal Ideation (SSI), Beck Depression Inventory (BDI), and Hamilton Anxiety Rating Scale (HAMA) focusing on 230min post-infusion. Results: At 230min post-infusion, correlations between changes in suicidal ideation and depression ranged from 0.23 to 0.44 (p<.05), accounting for up to 19% in the variance of ideation change. Correlations with anxiety ranged from 0.23 to 0.40 (p<.05), accounting for similar levels of variance. Ketamine infusion was associated with significant reductions in suicidal ideation compared to placebo, when controlling for the effects of ketamine on depression (F1,587=10.31, p=001) and anxiety (F1,567=8.54, p=004). Conclusions: Improvements in suicidal ideation after ketamine infusion are related to, but not completely driven by, improvements in depression and anxiety. Investigation of the specific effects of ketamine on suicidal thoughts is warranted.

KW - Depression

KW - Ketamine

KW - Suicidal ideation

KW - Suicide

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