Research library / Clinical trial
Ketamine for Rapid Reduction of Suicidal Thoughts in Major Depression: A Midazolam-Controlled Randomized Clinical Trial
Grunebaum MF, Galfalvy HC, Choo TH, et al. American Journal of Psychiatry 2018;175(4):327-335
Clinical trialKetaminedepressionsuicidal ideation
Rapidly reducing suicidal thoughts in depression might lower suicide risk. This trial gave 80 adults with major depression and significant suicidal thoughts a single infusion of either ketamine or midazolam, a sedative chosen because it has noticeable effects. A day later, suicidal thoughts had fallen more in the ketamine group, and 55% responded against 30%. Mood improved too, which explained about a third of the effect. Side effects passed quickly.
What it found
- 24 hours after the infusion, suicidal ideation scores fell 4.96 points more with ketamine than midazolam (95% CI 2.33 to 7.59; Cohen's d 0.75)
- 55% responded on ketamine against 30% on midazolam (number needed to treat 4)
- Side effects were short-lived; improvement held for up to 6 weeks with optimised standard medication in uncontrolled follow-up