Effects of Intravenous Ketamine on Explicit and Implicit Measures of Suicidality in Treatment-Resistant Depression

By Rebecca B. Price, Matthew K. Nock, Dennis S. Charney, S. Mathew. Biological Psychiatry, 2009

600 citations recorded by the source corpus.

Background Intravenous ketamine has shown rapid antidepressant effects in early trials, making it a potentially attractive candidate for depressed patients at imminent risk of suicide. The Implicit Association Test (IAT), a performance-based measure of association between two concepts, may have utility in suicide assessment. Methods Twenty-six patients with treatment-resistant depression were assessed for suicidality 2 hours prior to, and 24 hours following, a single subanesthetic dose of intravenous ketamine using the suicidality item of the Montgomery-Asberg Depression Rating Scale (MADRS-SI). Ten patients also completed IATs assessing implicit suicidal associations at comparable time points. In a second study, 9 patients received thrice-weekly ketamine infusions over a 12-day period. Results 24-hours after a single infusion, MADRS-SI scores were reduced by an average of 2.08 points on a 0–6 scale (p<.001; d=1.37), and 81% of patients received a rating of 0 or 1 post-infusion. Implicit associations between self- and escape-related words were also reduced following ketamine (p=.003; d=1.36), with reductions correlated across implicit and explicit measures. MADRS-SI reductions were sustained for 12 days by repeated-dose ketamine (2.9-point mean reduction; p<.001; d=2.42). Conclusions These preliminary findings support the premise that ketamine has rapid beneficial effects on suicidal cognition and warrants further study.

Subfields: Clinical Psychology, Experimental and Cognitive Psychology, Pharmacology

View Paper: https://www.semanticscholar.org/paper/e5ab535dff667a2940846b203e8b1751d9323ad1

How researchers see this paper

The researchers whose trusted networks rank it highest, strongest advocate first. Every researcher gets a different order.

In Clinical Psychology

1. L. Monteggia
2. Richard A. Bryant
3. F. Lotrich
4. J. Felger
5. E. Kavalali
6. Dennis S. Charney
7. E. Nestler
8. D. Cicchetti

In Experimental and Cognitive Psychology

1. L. Monteggia
2. Dennis S. Charney

In Pharmacology

1. L. Monteggia
2. Anita E. Autry
3. S. Mathew
4. Todd D. Gould
5. Dennis S. Charney

Citations in the corpus

• Ketamine and Ketamine Metabolite Pharmacology: Insights into Therapeutic Mechanisms (2018, background): “Additional studies have shown that ketamine reduces suicidal ideation (Price et al., 2009; DiazGranados et al., 2010b; Ballard et al., 2014) and decreases anhedonia (Lally et al.”
• BDNF — a key transducer of antidepressant effects (2015, background): “…in patients with depression, including treatment-resistant depression, has generated a great deal of interest in unraveling the underlying biological mechanisms mediating the fast acting response (Berman et al., 2000; DiozGranados et al., 2010a; 2010b; Price et al., 2009; Zarate et al., 2006a).”
• Inflammatory Cytokines in Depression: Neurobiological Mechanisms and Therapeutic Implications (2013, background): “…receptor antagonists, such as the NMDA antagonist, ketamine, have potent antidepressant effects especially in treatment resistant depressed patients (Price et al., 2009, aan het Rot et al., 2010), who, as mentioned previously (section 2.1), have been shown to exhibit increased inflammation.”
• Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders (2015, background): “Studies investigating its therapeutic effects have found a reduction in depressive symptoms in those suffering from treatment resistant depression along with mitigation of suicidality (Murrough et al., 2013; Price et al., 2009).”
• Rapid and Longer-Term Antidepressant Effects of Repeated Ketamine Infusions in Treatment-Resistant Major Depression (2012, positive): “ketamine may exert a unique anti-SI effect even in the absence of a full response and is consistent with previous reports highlighting the potential anti-SI effects of ketamine in depressed populations (10, 24, 25).”
• Brain-Derived Neurotrophic Factor and Neuropsychiatric Disorders (2012, background): “Recent evidence has suggested that ketamine, a well known anesthetic with NMDA receptor antagonist activity, is effective in very low doses for treatment of both MDD (Berman et al., 2000; Zarate et al., 2006; Price et al., 2009) and BD (Diazgranados et al., 2010).”
• NMDA Receptor Blockade at Rest Triggers Rapid Behavioural Antidepressant Responses (2011, methodology): “Analysis of variance (ANOVA) F(3,27) 5 30.”