Is ketamine efficacious for rapid treatment of acute suicidal ideation in an emergency setting? Lessons learned from a pilot randomized controlled trial.
BMC research notes – February 12, 2025
Source: PubMed
Summary
In the urgent battle against suicide, ketamine - a powerful N-methyl-d-aspartate receptor antagonist - shows promise for rapid relief. When compared to midazolam in emergency settings, both medications significantly reduced suicidal thoughts within 24 hours. While patients with severe depressive disorder saw improvement with either treatment, ketamine's established safety profile makes it a valuable option for crisis intervention.
Abstract
This study aimed to evaluate the efficacy of a single infusion of ketamine in inducing rapid remission of severe suicidal ideation, compared to Midazolam, in a population with acute suicidal thoughts. In a double-blind randomized controlled trial conducted in Tehran, Iran, from January to July 2022 (IRCT20220118053756N1), 36 inpatients with acute severe suicidal ideation were enrolled. Participants were randomly assigned to receive either a single dose of ketamine (0.5 mg/kg) or Midazolam (0.02 mg/kg). Suicidality was assessed using the Beck Scale for Suicide Ideation (BSSI) and the Suicide-Visual Analog Scale (S-VAS) before the intervention and at 12 and 24 h post-administration. At baseline, the Midazolam group exhibited significantly higher BSSI scores and a higher rate of borderline personality disorder than the Ketamine group. Mean BSSI and S-VAS scores at 12 and 24 h after the treatment decreased significantly compared to baseline in both groups. Despite these observations, no statistically significant differences were found between the groups in terms of BSSI and S-VAS scores. The protocol for this RCT was registered at the Iranian Registry of Clinical Trials (IRCT). The trial registration details are as follows: IRCT registration number IRCT20220118053756N1, with the registration date being June 12, 2022 (1401/03/22). It is important to note that this trial was retrospectively registered.