Rapid resolution of suicidal ideation after a single infusion of an N-methyl-D-aspartate antagonist in patients with treatment-resistant major depressive disorder.
Rapid resolution of suicidal ideation after a single infusion of an N-methyl-D-aspartate antagonist in patients with treatment-resistant major depressive disorder.
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DOI：
10.4088/jcp.09m05327blu
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发表时间：
2010-12
期刊：
影响因子：
--
通讯作者：
Zarate CA Jr
中科院分区：
文献类型：
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作者：
DiazGranados N;Ibrahim LA;Brutsche NE;Ameli R;Henter ID;Luckenbaugh DA;Machado-Vieira R;Zarate CA Jr
自杀意念是一种医疗紧急情况，特别是当严重时。关于可以解决这个问题的药物干预措施的研究很少。氯胺酮是一种N-甲基-D-天冬氨酸（NMDA）拮抗剂，据报道在数小时内具有抗抑郁作用。我们研究了单剂量氯胺酮对难治性重度抑郁症（MDD）受试者自杀意念的影响。33例DSM-IV诊断为MDD的受试者接受了氯胺酮（0.5 mg/kg）单次开放标签输注，并在基线、输注后40、80、120和230分钟使用自杀意念量表（SSI）、蒙哥马利-艾斯伯格抑郁评定量表（MADRS）、汉密尔顿抑郁评定量表（HDRS）和贝克抑郁量表（BDI）进行评定。在40分钟内，SSI以及其他评定工具的自杀子量表上的自杀意念评分显著降低;这些降低在输注后的前4小时内保持显著性（p<0.001）。10例受试者（30%）在基线时SSI评分为4分，所有受试者的评分均降至4分以下（9例40分钟，1例80分钟）。对于那些在SSI上低于4分的人，只有一个人达到了4分。抑郁、焦虑和绝望在所有时间点都有显着改善（p<.001）。MDD背景下的自杀意念在氯胺酮输注后40分钟内改善，并在输注后4小时内保持改善。由于氯胺酮对公共卫生的潜在影响，未来的自杀意念研究是必要的。
Suicidal ideation is a medical emergency, especially when severe. Little research has been done on pharmacological interventions that could address this problem. Ketamine, an N-methyl-D-aspartate (NMDA) antagonist, has been reported to have antidepressant effects within hours. We examined the effects of a single dose of ketamine on suicidal ideation in subjects with treatment-resistant major depressive disorder (MDD). Thirty-three subjects with DSM-IV-diagnosed MDD received a single open-label infusion of ketamine (0.5 mg/kg) and rated at baseline, 40, 80, 120, and 230 minutes post-infusion with the Scale for Suicide Ideation (SSI), the Montgomery-Asberg Depression Rating Scale (MADRS), the Hamilton Depression Rating Scale (HDRS), and the Beck Depression Inventory (BDI). Suicidal ideation scores decreased significantly on the SSI as well as on the suicide subscales of other rating instruments within 40 minutes; these decreases remained significant through the first four hours post-infusion (p<.001). Ten subjects (30%) had a SSI score 4 at baseline, and all dropped below a score of 4 (nine by 40 minutes and one by 80 minutes). For those starting below a score of 4 on the SSI, only one reached a score of 4. Depression, anxiety, and hopelessness were significantly improved at all time points (p<.001). Suicidal ideation in the context of MDD improved within 40 minutes of a ketamine infusion and remained improved for up to four hours post-infusion. Future studies with ketamine in suicidal ideation are warranted due to its potential impact on public health.