Gaither Rachel, Ranney Megan, Peachey Alyssa, Burock Jeffrey, Rogers Jyllian, Bucci Lindsey, Beaudoin Francesca L
Department of Epidemiology Brown University School of Public Health Providence Rhode Island USA.
Department of Emergency Medicine The Alpert Medical School of Brown University Providence Rhode Island USA.
J Am Coll Emerg Physicians Open. 2022 Aug 15;3(4):e12790. doi: 10.1002/emp2.12790. eCollection 2022 Aug.
Mood disorders complicated by suicidal ideation (SI) frequently present to the emergency department (ED) for care. Currently, patients with SI in the ED do not typically receive targeted interventions. Ketamine may have a role in treating SI within the ED because subanesthetic doses have rapid-acting antidepressant and antisuicidal properties.
This single-arm, open-label feasibility study enrolled 14 participants from the ED with acute SI who were awaiting voluntary admission to inpatient psychiatry to receive ketamine at 0.5 mg/kg, administered intravenously. Participants were assessed post administration to evaluate feasibility of administration in the ED and short-term effectiveness. Feasibility was determined by acceptability by patients and physicians as well as tolerability and ability to recruit participants into the study. Efficacy was assessed based on changes in (1) self-reported mood and (2) suicidal ideation pre- and postinfusion of ketamine.
All patients reported severe depression and active SI at baseline. No serious adverse events were reported, and acceptability was rated highly by both participants and physicians (>70%). Two hours after receiving ketamine 0.5 mg/kg, the mean SI and somatic symptom burden were decreased compared to baseline ( < 0.001 and = 0.005, respectively), and the mean self-reported mood was increased ( = 0.006). Improvements in mood and decreases in suicidality persisted at 6 hours.
Overall, ketamine was well tolerated, considered feasible by both participants and physicians, and demonstrated short-term efficacy. There is a growing body of evidence demonstrating the feasibility of ketamine administration in the ED, and larger randomized trials should be conducted to establish treatment recommendations for patients with SI in the ED.
伴有自杀意念（SI）的情绪障碍患者常前往急诊科（ED）寻求治疗。目前，急诊科有自杀意念的患者通常未接受针对性干预。氯胺酮可能在急诊科治疗自杀意念方面发挥作用，因为亚麻醉剂量具有快速起效的抗抑郁和抗自杀特性。
这项单臂、开放标签的可行性研究招募了14名来自急诊科、有急性自杀意念且等待自愿入住精神科病房的参与者，静脉注射0.5mg/kg氯胺酮。给药后对参与者进行评估，以评估在急诊科给药的可行性和短期有效性。可行性由患者和医生的可接受性以及耐受性和招募参与者进入研究的能力来确定。疗效根据以下两方面的变化进行评估：（1）自我报告的情绪；（2）氯胺酮输注前后的自杀意念。
所有患者在基线时均报告有严重抑郁和活跃的自杀意念。未报告严重不良事件，参与者和医生对可接受性的评分均很高（>70%）。接受0.5mg/kg氯胺酮两小时后，与基线相比，平均自杀意念和躯体症状负担降低（分别为P<0.001和P = 0.005），自我报告的平均情绪有所改善（P = 0.006）。情绪改善和自杀倾向降低在6小时时持续存在。
总体而言，氯胺酮耐受性良好，参与者和医生均认为可行，并显示出短期疗效。越来越多的证据表明在急诊科给予氯胺酮是可行的，应进行更大规模的随机试验，为急诊科有自杀意念的患者制定治疗建议。
