National Institute of Mental Health, and Department of Human Health Services, Bethesda, Maryland, USA.
J Clin Psychiatry. 2010 Dec;71(12):1605-11. doi: 10.4088/JCP.09m05327blu. Epub 2010 Jul 13.
Suicidal ideation is a medical emergency, especially when severe. Little research has been done on pharmacologic interventions that could address this problem. Ketamine, an N-methyl-D-asparate antagonist, has been reported to have antidepressant effects within hours. We examined the effects of a single dose of ketamine on suicidal ideation in subjects with treatment-resistant major depressive disorder (MDD).
Thirty-three subjects with DSM-IV-diagnosed MDD received a single open-label infusion of ketamine (0.5 mg/kg) and were rated at baseline and at 40, 80, 120, and 230 minutes postinfusion with the Scale for Suicide Ideation (SSI), the Montgomery-Åsberg Depression Rating Scale, the Hamilton Depression Rating Scale, and the Beck Depression Inventory. The study was conducted between October 2006 and January 2009.
Suicidal ideation scores decreased significantly on the SSI as well as on the suicide subscales of other rating instruments within 40 minutes; these decreases remained significant through the first 4 hours postinfusion (P < .001). Ten subjects (30%) had an SSI score ≥ 4 at baseline; all these scores dropped below 4 (9 dropped by 40 minutes and 1 by 80 minutes). For those patients with a starting score below 4 on the SSI, only 1 reached a score of 4. Depression, anxiety, and hopelessness were significantly improved at all time points (P < .001).
Suicidal ideation in the context of MDD improved within 40 minutes of a ketamine infusion and remained improved for up to 4 hours postinfusion. Future studies with ketamine in suicidal ideation are warranted due to the potential impact on public health.
clinicaltrials.gov Identifier: NCT00088699.
自杀意念是一种医疗紧急情况，尤其是严重的情况。关于可能解决这一问题的药物干预措施，研究甚少。氯胺酮是一种 N-甲基-D-天冬氨酸拮抗剂，据报道其在数小时内具有抗抑郁作用。我们研究了单次氯胺酮给药对治疗抵抗性重度抑郁症（MDD）患者自杀意念的影响。
33 名符合 DSM-IV 诊断的 MDD 患者接受单次开放标签氯胺酮输注（0.5mg/kg），并在输注后 40、80、120 和 230 分钟时使用自杀意念量表（SSI）、蒙哥马利-阿斯伯格抑郁评定量表、汉密尔顿抑郁评定量表和贝克抑郁量表进行评分。研究于 2006 年 10 月至 2009 年 1 月进行。
SSI 以及其他评定工具的自杀子量表的自杀意念评分在 40 分钟内显著降低；这些降低在输注后 4 小时内仍保持显著（P<0.001）。10 名患者（30%）在基线时 SSI 评分≥4；所有这些评分均降至 4 以下（9 名患者在 40 分钟时下降，1 名患者在 80 分钟时下降）。对于 SSI 基线评分低于 4 的患者，只有 1 名患者的评分达到 4。抑郁、焦虑和绝望感在所有时间点均显著改善（P<0.001）。
在 MDD 背景下，自杀意念在氯胺酮输注后 40 分钟内得到改善，并在输注后 4 小时内持续改善。由于氯胺酮对公共健康的潜在影响，未来有必要进行氯胺酮治疗自杀意念的研究。
clinicaltrials.gov 标识符：NCT00088699。
