Pathak Umesh, Ahuja Sunil Kumar, Dwivedi Rajeev, Mishra Nimisha, Kumar Pradeep, Mishra Dheerendra Kumar, Singh Rajesh
Department of Psychiatry, Shyam Shah Medical College, Rewa, Madhya Pradesh, India.
Department of Anaesthesia, Super Specialty Hospital and Shyam Shah Medical College, Rewa, Madhya Pradesh, India.
Indian J Psychiatry. 2021 Sep-Oct;63(5):483-489. doi: 10.4103/indianjpsychiatry.indianjpsychiatry_80_21. Epub 2021 Oct 12.
The efficacy of ketamine in the rapid alleviation of depressive and suicidal symptoms has been observed over the past few years around the globe. Exploration of rapid antisuicidal efficacy of ketamine in Indian subpopulation can be a good preventive pharmacological option for unprecedented rise in suicides in India.
To assess efficacy of ketamine infusions on suicidal patients of depressive disorder. Severity of depression and suicidality were quantified daily over 1 week.
This was a randomized control study, comprised sixty patients of age group 18-60 years, with a diagnosis of depressive episode, having the Modified Scale for Suicidal Ideations (MSSI) score >20 with exclusion of severe medical or surgical illness, pregnancy, and breast-feeding females. Patient were assigned to ketamine and normal saline group. Three infusions were given over 1 week on day 0, day 2, and day 4. Assessments were made at baseline using the 17-item Hamilton Depression Rating Scale (HAM-D17) and MSSI, for depression and suicidality, respectively. Assessments were repeated at 6 h after first infusion and then every day for 1 week.
There were significant reductions in HAM-D17 score and MSSI score within 6 h of the first dose in the ketamine group as compared to the normal saline group. Significant sustained improvement was seen on further days till 1 week in the ketamine group as compared to the normal saline group.
Ketamine might be a reasonable choice to fulfil the efficacy gap created by the delayed antisuicidal onset of standard treatments.
在过去几年中，全球范围内均观察到氯胺酮在快速缓解抑郁和自杀症状方面的疗效。探索氯胺酮在印度亚人群中的快速抗自杀疗效，对于印度自杀率前所未有的上升而言，可能是一种良好的预防性药理学选择。
评估氯胺酮输注对抑郁症自杀患者的疗效。在1周内每天对抑郁和自杀倾向的严重程度进行量化。
这是一项随机对照研究，纳入60名年龄在18 - 60岁之间、诊断为抑郁发作、改良自杀观念量表（MSSI）评分>20的患者，排除患有严重内科或外科疾病、妊娠及哺乳期女性。患者被分为氯胺酮组和生理盐水组。在第0天、第2天和第4天的1周内进行三次输注。分别使用17项汉密尔顿抑郁量表（HAM-D17）和MSSI在基线时对抑郁和自杀倾向进行评估。在首次输注后6小时进行评估，然后每天评估1周。
与生理盐水组相比，氯胺酮组在首次给药后（6小时内）HAM-D17评分和MSSI评分显著降低。与生理盐水组相比，氯胺酮组在直至1周的后续几天内均有显著持续改善。
氯胺酮可能是填补标准治疗抗自杀起效延迟所造成疗效差距的合理选择。
