Efficacy And Safety Of Repeated Ketamine Infusions In Depression With Suicidal Ideation

Background:Depression is a common mental disorder,with a lifetime prevalence rate of approximately 16%and a suicide rate of 15%-20%,which affects the social function of individuals seriously.Unfortunately,most currently treatment of depression with suicidal ideation fail to relieve symptoms quickly.Previous studies found that ketamine intervention could rapidly reduce suicidal ideation and depressive symptom in depression.However,the comparatively study in Chinese population remains absence.This study aims to assess the anti-suicidal efficacy of repeated ketamine infusions in Chinese depressed suicidal patient.Methods:Eighty-six unipolar and bipolar depressive patients with current suicidal ideation received six ketamine infusions during a 12-day period.Hamilton Depression Rating Scale(HAMD),Beck Scale for Suicide Ideation(SSI),Hamilton Anxiety Scale(HAMA),Brief Psychiatric Rating Scale(BPRS)and Clinician Administered Dissociative States Scale(CADSS)was measured at baseline,4 hours and 24 hours after each infusion,and two-week naturalistically follow-up Neurocognitive performance(MCCB)was evaluated at baseline,day 13 and day 26Results:Forty-nine(57.0%)patients relief of suicidal ideation after first infusion and 56(65.1%)after six infusions.Anti-suicidal response rate in low SI group were higher than high SI group,and anti-suicidal response at 4 hours after first infusion was significant predictor of response at 24 hours after sixth infusion.Meanwhile,59.3%and 40.7%patients met the criteria of antidepressant response and remission after six ketamine infusions,respectively.What's more,at 24 hours after the sixth infusion,correlation between changes in suicidal ideation and depression was 0.23,accounting for 7.4%in the variance of suicidal ideation change.Speed of processing(F=229.37,p<0.001)and verbal learning(F=6.89,p<0.001)were significantly improved after six ketamine infusions.Change in SSI was correlated with change in working memory on day 13.Better baseline visual learning was able to predict better anti-suicidal response after six ketamine infusions(B=0.072,p=0.041)Conclusions:In this study,an open-label design was used to explore the efficacy and safety of repeated ketamine infusions in depressed patients with suicidal ideation.We confirmed that six repeated ketamine infusions for Chinese suicidal depressed patients were effective in generating a rapid response of suicidal ideation and depressive symptoms.Besides,a decrease in suicidal ideation was associated with an improvement in depressive symptoms.Neurocognitive function would not deteriorate after six ketamine infusions.3.5%patients appeared suicidal behavior during the course of infusions..