Effects of Ketamine Versus Midazolam on Neurocognition at 24 Hours in Depressed Patients With Suicidal Ideation
Date
2021-11-10
Authors
Keilp, John G.
Madden, Sean P.
Marver, Julia E.
Frawley, Abigail
Burke, Ainsley K.
Herzallah, Mohammad M.
Gluck, Mark
Mann, J. John
Journal Title
Journal ISSN
Volume Title
Publisher
Physicians Postgraduate Press, Inc.
Abstract
You are prohibited from making this PDF publicly available.For reprints or permissions, contact permissions@psychiatrist.com. ♦ © 2021 Copyright Physicians Postgraduate Press, Inc.It is illegal to post this copyrighted PDF on any website. e1J Clin Psychiatry 82:6, November/December 2021
Focus on Suicide
ABSTRACT
Objective: Subanesthetic ketamine rapidly reduces depressive
symptoms and suicidal ideation in some depressed patients. Its
effects on neurocognitive functioning in such individuals with
significant suicidal ideation is not well understood, even though
certain neurocognitive deficits are associated with suicide behavior
beyond clinical symptoms.
Methods: In this study, depressed patients with clinically
significant suicidal ideation (n = 78) underwent neuropsychological
testing before and 1 day after double-blind treatment with
intravenous ketamine (n = 39) or midazolam (n = 39). A subgroup
randomized to midazolam whose ideation did not remit after initial
infusion received open ketamine and additional neurocognitive
testing a day after this treatment. The primary outcome was
change in performance on this neurocognitive battery. The study
was conducted between November 2012 and January 2017.
Results: Blinded ketamine produced rapid improvement in suicidal
ideation and mood in comparison to midazolam, as we had
reported previously. Ketamine, relative to midazolam, was also
associated with specific improvement in reaction time (Choice
RT) and interference processing/cognitive control (computerized
Stroop task)—the latter a measure that has been associated with
past suicide attempt in depression. In midazolam nonremitters
later treated with open ketamine and retested, reaction time and
interference processing/cognitive control also improved relative
to both of their prior assessments. Neurocognitive improvement,
however, was not correlated with changes in depression, suicidal
thinking, or general mood.
Conclusions: Overall, ketamine was found to have a positive
therapeutic effect on neurocognition 1 day after treatment on at
least 1 measure associated with suicidal behavior in the context of
depression. Results suggest additional independent therapeutic
effects for ketamine in the treatment of depressed patients at risk
for suicidal behavior.