Repeat-dose ketamine augmentation for treatment-resistant depression with chronic suicidal ideation: A randomized, double blind, placebo controlled trial.
D. Ionescu, Kate H Bentley, M. Eikermann, N. Taylor, O. Akeju, M. Swee, Kara J. Pavone, S. Petrie, C. Dording, D. Mischoulon, J. Alpert, E. Brown, L. Baer, M. Nock, M. Fava, C. Cusin
Journal of Affective Disorders January 1, 2019 DOI: 10.1016/j.jad.2018.09.037 via Semantic Scholar
Summary
Repeated doses of ketamine did not reduce depression or suicidal ideation more than placebo in outpatients with severe, treatment-resistant depression and chronic suicidal thoughts. Twenty-six medicated adults received six infusions of ketamine or saline over three weeks. Neither depression severity nor suicidal ideation differed between groups during the infusion phase. At three months, two patients in each group had remitted from depression. The authors suggest that the standard 0.5 mg/kg dose may be insufficient for this severely ill outpatient population.
Study at a glance
| Characteristics | Randomized controlled trial Placebo-controlled Double-blind Open-label Peer reviewed |
|---|---|
| Sample size | 26 |
| Population | Medicated outpatients with severe major depressive disorder and current, chronic suicidal ideation |
| Keywords | Medicine Psychology |
| Citations | 179 |
| Key finding | Repeated ketamine infusions did not outperform placebo in reducing depression or suicidal ideation among outpatients with treatment-resistant depression and chronic suicidal ideation. |
Abstract
BACKGROUND Several studies indicate that ketamine has rapid antidepressant effects in patients with treatment-resistant depression (TRD). The extent to which repeated doses of ketamine (versus placebo) reduce depression in the short and long term among outpatients with TRD and chronic, current suicidal ideation remains unknown. METHODS Twenty-six medicated outpatients with severe major depressive disorder with current, chronic suicidal ideation were randomized in a double-blind fashion to six ketamine infusions (0.5 mg/kg over 45 minutes) or saline placebo over three weeks. Depression and suicidal ideation were assessed at baseline, 240 min post-infusion, and during a three-month follow-up phase. RESULTS During the infusion phase, there was no differences in depression severity or suicidal ideation between placebo and ketamine (p = 0.47 and p = 0.32, respectively). At the end of the infusion phase, two patients in the ketamine group and one in the placebo group met criteria for remission of depression. At three-month follow-up, two patients in each group met criteria for remission from depression. LIMITATIONS Limitations include the small sample size, uncontrolled outpatient medication regimens, and restriction to outpatients, which may have resulted in lower levels of suicidal ideation than would be seen in emergency or inpatient settings. CONCLUSIONS Repeated, non-escalating doses of ketamine did not outperform placebo in this double-blind, placebo controlled study of patients with severe TRD and current, chronic suicidal ideation. This result may support our previously published open-label data that, in this severely and chronically ill outpatient population, the commonly used dose of 0.5 mg/kg is not sufficient.