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Ketamine augmentation for major depressive disorder and suicidal ideation: preliminary experience in an inpatient psychiatry setting

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dc.contributor.author Sinyor, Mark
dc.contributor.author Williams, Marissa
dc.contributor.author Belo, Sue
dc.contributor.author Orser, Beverley
dc.contributor.author Vincent, Margaret
dc.contributor.author Mah, Linda
dc.contributor.author Zarate, Carlos
dc.contributor.author Castel, Saulo
dc.contributor.author Levitt, Anthony J.
dc.contributor.author Schaffer, Ayal
dc.date.accessioned 2018-08-21T13:32:00Z
dc.date.issued 2018
dc.identifier.uri http://hdl.handle.net/10344/7082
dc.description peer-reviewed en_US
dc.description.abstract Background Ketamine is known to rapidly reduce depressive symptoms and suicidal ideation (SI) in patients with major depressive disorder (MDD), but evidence is limited for its acceptability and effectiveness in “real-world” settings. This case series examines serial ketamine infusions in reducing SI and depression scores in adults with MDD admitted to a tertiary care hospital. Methods Five inpatients with MDD and SI admitted to hospital in Toronto, Canada received six infusions of 0.5 mg/kg intravenous (IV) ketamine (n = 5) over approximately 12 days, in addition to treatment-as-usual. Suicide and depression rating scores (Scale for Suicidal Ideation, SSI; Montgomery-Åsberg Depression Rating Scale, MADRS) were obtained at baseline, on treatment days, on days 14 and 42 (primary endpoint). Results All patients experienced benefit with ketamine. SSI scores diminished by 84% from 14.0 ± 4.5 at baseline to 2.2 ± 2.5 at study endpoint. MADRS scores diminished by 47% from 42.2 ± 5.3 at baseline to 22.4 ± 8.0. Two patients withdrew from the study, one to initiate electroconvulsive therapy and one due to an adverse event (dissociative effects) during the ketamine infusion. Limitations The major limitation of this study is the small sample size. Discussion These preliminary pilot data are promising with a greater than two-fold reduction in SI following ketamine infusions. They demonstrate that six serial ketamine infusions may be safe and feasible. These findings support the need for large scale randomized controlled trials to confirm the efficacy of serial ketamine for treatment of SI in “real-world” settings en_US
dc.language.iso eng en_US
dc.publisher Elsevier en_US
dc.relation.ispartofseries Journal of Affective Disorders;241, pp. 103-109
dc.relation.uri https://doi.org/10.1016/j.jad.2018.07.073
dc.rights This is the author’s version of a work that was accepted for publication in Journal of Affective Disorders. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Journal of Affective Disorders, 2018, 241, pp. 103-109, https://doi.org/10.1016/j.jad.2018.07.073 en_US
dc.subject major depressive disorder en_US
dc.subject suicide en_US
dc.subject ketamine en_US
dc.subject midazolam en_US
dc.subject inpatients en_US
dc.title Ketamine augmentation for major depressive disorder and suicidal ideation: preliminary experience in an inpatient psychiatry setting en_US
dc.type info:eu-repo/semantics/article en_US
dc.type.supercollection all_ul_research en_US
dc.type.supercollection ul_published_reviewed en_US
dc.identifier.doi 10.1016/j.jad.2018.07.073
dc.contributor.sponsor Dr. Brenda Smith Bipolar Fund (Toronto Canada) en_US
dc.date.embargoEndDate 2019-07-29
dc.embargo.terms 2019-07-29 en_US
dc.rights.accessrights info:eu-repo/semantics/openAccess en_US


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