Study: Suicidal Thoughts Rapidly Reduced with Ketamine
Ketamine was significantly more effective than a commonly used sedative in reducing suicidal thoughts in depressed patients, according to researchers at Columbia University Medical Center (CUMC). They also found that ketamine's anti-suicidal effects occurred within hours after its administration.
The findings were published online last week in the American Journal of Psychiatry.
Ketamine for Rapid Reduction of Suicidal Thoughts in Major Depression: A Midazolam-Controlled Randomized Clinical Trial (DOI: 10.1176/appi.ajp.2017.17060647) (DX)
The reduction in SSI score at day 1 was 4.96 points greater for the ketamine group compared with the midazolam group (95% CI=2.33, 7.59; Cohen's d=0.75). The proportion of responders (defined as having a reduction ≥50% in SSI score) at day 1 was 55% for the ketamine group and 30% for the midazolam group (odds ratio=2.85, 95% CI=1.14, 7.15; number needed to treat=4.0). Improvement in the Profile of Mood States depression subscale was greater at day 1 for the ketamine group compared with the midazolam group (estimate=7.65, 95% CI=1.36, 13.94), and this effect mediated 33.6% of ketamine's effect on SSI score. Side effects were short-lived, and clinical improvement was maintained for up to 6 weeks with additional optimized standard pharmacotherapy in an uncontrolled follow-up.
Wikipedia's entry on midazolam notes:
Midazolam, marketed under the trade name Versed, among others, is a medication used for anesthesia, procedural sedation, trouble sleeping, and severe agitation. It works by inducing sleepiness, decreasing anxiety, and causing a loss of ability to create new memories. It is also useful for the treatment of seizures
Related: 4/20: The Third Time's Not the Charm
Study Suggests Psilocybin "Resets" the Brains of Depressed People
(Score: 4, Insightful) by Anonymous Coward on Sunday December 17 2017, @05:06AM (1 child)
You fundamentally misunderstand depression.
(Score: 3, Interesting) by Hartree on Sunday December 17 2017, @08:19PM
Bingo. As someone who has had to deal with (well controlled) major depression for decades, I can tell you it's a lot more than just letting things build up on you. That's what you see from the outside, but the effect is that of putting a negative cast on the world no matter what the reality is. And that viewpoint is just as hard to disbelieve as telling yourself that the fire your hand is smoldering in is not real and you should ignore it. (Yes, it can be done to some extent, but just telling someone to do it without a lot of training (therapy, etc.) is probably futile)
The way it's starting to appear Ketamine works for depression is to some extent unrelated to the subjective feelings it generates in your mind. Though it dissociates some of the pain, it apparently (the research is still ongoing) causes the rapid formation of many more synapse junctions between nerve cells in some parts of the brain. That may be why the antidepressant effects seem to be delayed by a few hours. You have to synthesize all the proteins and other components of those new synapses and move them into place.
Similarly, some researchers suspect that the delay of weeks for SSRIs to take effect is that nerve cells are developing from neural stem cells and moving into position. Not surprisingly, this takes time.
I put all those qualifiers in because this is a very active area of research and we don't understand it very well. This is the best guess the last I knew, but is subject to someone finding out that parts or all of it is wrong. That's science in action.