Effect of intravenous ketamine on suicidality in adults with treatment-resistant depression: A real world effectiveness study

IF 4.2 2区医学 Q1 PSYCHIATRY

Psychiatry Research Pub Date : 2024-11-23 DOI:10.1016/j.psychres.2024.116282

David C.J. Chen-Li , Rodrigo B. Mansur , Joshua D. Di Vincenzo , Noah Chisamore , Erica Kaczmarek , Roger S. McIntyre , Joshua D. Rosenblat

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Abstract

Suicidal ideation is a significant symptom associated with mood disorders. Ketamine is an emerging treatment with rapid and robust antidepressant and antisuicidal effects observed in clinical trial populations. Herein we assessed the real-world effectiveness of ketamine in ameliorating suicidality. A retroactive chart analysis of 96 adult TRD patients that received treatment in a private community clinic in Toronto, Ontario was conducted. Suicidality and depressive symptom outcomes were assessed with the Columbia Suicide Severity Rating Scale (C-SSRS) (self-report version) and the Quick Inventory for Depressive Symptomatology Self-Report 16-Item (QIDS-SR16) respectively. The effect of ketamine on suicidal ideation was modelled using generalized estimating equations adjusting for demographic predictors and depressive symptom severity. A mediation analysis was conducted to evaluate the contribution of the antidepressant effects of ketamine on its antisuicidal properties. Mean C-SSRS score significantly decreased following a single ketamine infusion and was indicative of a reduction in suicidality from active to passive suicidal ideation on a group level. Results of the mediation analysis indicated that the antisuicidal effects of ketamine are partially independent of its antidepressant effects. Our study supports the use of ketamine in treating suicidal ideation in a real-world setting with benefits comparable to clinical trials.

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静脉注射氯胺酮对成人难治性抑郁症自杀的影响：一项真实世界的有效性研究。

自杀意念是与情绪障碍相关的重要症状。氯胺酮是一种新兴的治疗方法，在临床试验人群中观察到快速和强大的抗抑郁和抗自杀效果。在此，我们评估了氯胺酮在改善自杀倾向方面的实际有效性。回顾性分析了96例在安大略省多伦多市一家私人社区诊所接受治疗的成人TRD患者。分别用哥伦比亚自杀严重程度评定量表（C-SSRS）（自报告版）和抑郁症状快速量表（QIDS-SR16）评估自杀倾向和抑郁症状结局。氯胺酮对自杀意念的影响采用广义估计方程进行建模，调整人口统计学预测因子和抑郁症状严重程度。通过中介分析来评价氯胺酮的抗抑郁作用对其抗自杀特性的影响。单次氯胺酮输注后，平均C-SSRS评分显著下降，表明在组水平上自杀意念从主动减少到被动。中介分析结果表明氯胺酮的抗自杀作用部分独立于其抗抑郁作用。我们的研究支持在现实世界中使用氯胺酮治疗自杀意念，其益处与临床试验相当。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Psychiatry Research 医学-精神病学

CiteScore

17.40

自引率

1.80%

发文量

527

审稿时长

57 days

期刊介绍： Psychiatry Research offers swift publication of comprehensive research reports and reviews within the field of psychiatry. The scope of the journal encompasses: Biochemical, physiological, neuroanatomic, genetic, neurocognitive, and psychosocial determinants of psychiatric disorders. Diagnostic assessments of psychiatric disorders. Evaluations that pursue hypotheses about the cause or causes of psychiatric diseases. Evaluations of pharmacologic and non-pharmacologic psychiatric treatments. Basic neuroscience studies related to animal or neurochemical models for psychiatric disorders. Methodological advances, such as instrumentation, clinical scales, and assays directly applicable to psychiatric research.