S-Ketamine in the treatment of depressive emergencies: a cases series of patients in a suicidal crisis

Intranasal S-ketamine (Spravato) can be safely and effectively administered in an acute psychiatric emergency setting to treat depressive crises in patients with treatment-resistant major depressive disorder who have severe suicidal ideation. In a case series of 10 patients (70% female, mean age 49.5 years), average MADRS scores dropped from 37 pre-treatment to 18 post-treatment, and BDI scores dropped from 39 to 24. Side effects such as dissociation were short-lived.

Study at a glance

Abstract

Introduction Psychiatric emergencies in Major Depressive Disorder (MDD) are characterised by multiple types of symptoms including risk of self-harm and suicidal ideation. S-ketamine intranasally (Spravato) has recently been shown to help alleviate symptoms during depressive emergencies. In this case-series, we detail the clinical effects and usability of S-ketamine applied intranasally in a psychiatric emergency setting. Objectives To describe the effects of S-Ketamine on depressive crises associated with suicidality and self-harm in a psychiatric emergency setting. Methods Patients with MDD in a psychiatric emergency were provided with intranasal S-Ketamine according to clinical indication in routine clinical care in a University inpatient setting. Clinical characteristics were assessed in a standardised manner and symptom measures were applied pre-and posttreatment. Experience with 10 patients is systematically described in this case-series. Results Patients had a primary diagnosis of MDD accompanied by a variety of secondary psychiatric comorbidity. Among these 10 patients, the majority were female (70 %) and the mean age was 49.5 yrs (range 26-66). All cases were considered treatment resistant and suffered severe acute suicidal ideation. Across all cases, pre-treatment MADRS was 37 on average (range 20-47) indicating a severe form of MDD. High severity was confirmed in elevated BDI scores (pre-treatment 39). Post-treatment, MADRS scores were reduced to 18 on average, alongside BDI scores (mean 24). S-ketamine administration was well-tolerated and side effects such as dissociation were of short-lived duration. Conclusions S-Ketamine intranasally can be safely and effectively administered in an acute psychiatric setting to treat psychiatric emergencies. Disclosure BTB received honoraria for consultancy and presentations from AstraZeneca, Bristol-Myers Squibb, Lundbeck, Pfizer, Servier, Wyeth, LivaNova, Janssen, Novartis, Otsuka, Angelini.