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Improvement in suicidal ideation after ketamine infusion: relationship to reductions in depression and anxiety.

ABSTRACT: OBJECTIVE:Suicide is a psychiatric emergency. Currently, there are no approved pharmacologic treatments for suicidal ideation. Ketamine is an N-methyl-D-aspartate (NMDA) receptor antagonist that rapidly reduces suicidal ideation as well as depression and anxiety, but the dynamic between these symptoms is not known. The aim of this analysis was to evaluate whether ketamine has an impact on suicidal thoughts, independent of depressive and anxiety symptoms. METHODS:133 patients with treatment-resistant depression (major depressive disorder or bipolar I/II disorder) received a single subanesthetic infusion of ketamine (0.5 mg/kg over 40 min). Post-hoc correlations and linear mixed models evaluated the relationship between suicidal ideation and depression and anxiety symptoms using the Hamilton Depression Rating Scale (HAMD), Scale for Suicidal Ideation (SSI), Beck Depression Inventory (BDI), and Hamilton Anxiety Rating Scale (HAMA) focusing on 230 min post-infusion. RESULTS:At 230 min post-infusion, correlations between changes in suicidal ideation and depression ranged from 0.23 to 0.44 (p < .05), accounting for up to 19% in the variance of ideation change. Correlations with anxiety ranged from 0.23 to 0.40 (p < .05), accounting for similar levels of variance. Ketamine infusion was associated with significant reductions in suicidal ideation compared to placebo, when controlling for the effects of ketamine on depression (F1,587 = 10.31, p = .001) and anxiety (F1,567 = 8.54, p = .004). CONCLUSIONS:Improvements in suicidal ideation after ketamine infusion are related to, but not completely driven by, improvements in depression and anxiety. Investigation of the specific effects of ketamine on suicidal thoughts is warranted.

SUBMITTER: Ballard ED

PROVIDER: S-EPMC4163501 | biostudies-literature | 2014 Nov

REPOSITORIES: biostudies-literature

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Improvement in suicidal ideation after ketamine infusion: relationship to reductions in depression and anxiety.

Ballard Elizabeth D ED Ionescu Dawn F DF Vande Voort Jennifer L JL Niciu Mark J MJ Richards Erica M EM Luckenbaugh David A DA Brutsché Nancy E NE Ameli Rezvan R Furey Maura L ML Zarate Carlos A CA

Journal of psychiatric research 20140812

<h4>Objective</h4>Suicide is a psychiatric emergency. Currently, there are no approved pharmacologic treatments for suicidal ideation. Ketamine is an N-methyl-D-aspartate (NMDA) receptor antagonist that rapidly reduces suicidal ideation as well as depression and anxiety, but the dynamic between these symptoms is not known. The aim of this analysis was to evaluate whether ketamine has an impact on suicidal thoughts, independent of depressive and anxiety symptoms.<h4>Methods</h4>133 patients with ...[more]

PMID: 25169854

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Project description:ObjectiveIt is recognised that ketamine treatment can reduce suicidal ideation (SI) in people with depression, at least in the short term. However, information is lacking on patients' perspectives on such effects. Studying these can contribute to greater understanding of the mechanisms underlying impact of ketamine treatment on SI. The aim of this study was to investigate patients' reports of the impact of treatment on their SI, the duration of effects and possible mechanisms.Design and settingThis qualitative study consisted of semi-structured interviews with patients who had received ketamine treatment for depression. Interview data were analysed thematically.ParticipantsFourteen patients (8 females, 6 males, aged 24-64 years) who had received treatment with ketamine for treatment-resistant depression, and had SI at the initiation of treatment. Two participants also had a diagnosis of bipolar type 1 and two of emotionally unstable personality disorder. Eight had a history of self-harm.ResultsSI reduced following ketamine treatment in 12 out of 14 participants for periods of a few hours following a single treatment to up to three years with ongoing treatment. Reduction of SI was variable in terms of extent and duration, and re-emergence of suicidal thoughts often occurred when treatment ceased. Participants' accounts indicated that reduced SI was associated with improved mood and reduced anxiety, as were clarity of thought, focus and concentration, and ability to function. Participants reported experiencing some or all of these effects in various orders of occurrence.ConclusionGenerally, ketamine treatment was experienced as effective in reducing SI, although duration of effects varied considerably. Patients' perspectives indicated similarities in the mechanisms of reduction in SI, but some differences in their manifestation, particularly in relation to chronology. Experiences of this cohort suggest that reduced anxiety and improvement in ability to think and function were important mechanisms alongside, or in some cases independently of, improvement in mood. Further studies of patients' experiences are required to gain enhanced understanding of the variability of effects of ketamine on SI and functionality.

Project description:ImportanceMental health problems are common during the transition from adolescence to young adulthood. Although perceived social support and mental health problems have been shown to be concurrently associated, longitudinal studies are lacking to document the directionality of this association, especially in emerging adulthood (late teens to late 20s).ObjectiveTo test whether social support in emerging adulthood protects against later depression, anxiety, and suicidal ideation and suicide attempts after adjusting for a range of confounders, including prior mental health problems and family characteristics.Design, setting, and participantsThis population-based cohort study included 1174 participants from the Quebec Longitudinal Study of Child Development. Participants underwent yearly or biennial assessment (starting from age 5 months to age 20 years). Data were collected from March 16, 1998, through June 1, 2018.Main outcomes and measuresSelf-reported perceived social support was measured at age 19 years using the 10-item Social Provision Scale. Mental health problems, including depressive and anxiety symptoms as well as suicidal ideation and attempts, were measured at age 20 years. Social support and mental health problem raw scores were converted to z-scores to ease interpretation. Depressive and anxiety symptoms were categorized using validated cutoffs to determine clinical significance.ResultsThe study consisted of 1174 participants (574 female [48.89%] and 600 male [51.11%] individuals). Emerging adults with higher levels of perceived social support at age 19 years reported fewer mental health problems 1 year later, even after adjusting for a range of mental health problems in adolescence at ages 15 and 17 years (eg, depressive and anxiety symptoms and suicidal ideation and attempts) and family characteristics (eg, socioeconomic status and family functioning and structure). Higher perceived social support was associated with fewer symptoms of depression (β = -0.23; 95% CI, -0.26 to -0.18; P = <.001 and odds ratio [OR], 0.53; 95% CI, 0.42-0.66 for severe depression) and anxiety (β = -0.10; 95% CI, -0.15 to -0.04; P < .001 and OR, 0.78; 95% CI, 0.62-0.98 for severe anxiety). Higher perceived social support was associated with a lower risk for suicide-related outcomes (OR, 0.59 [95% CI, 0.50-0.70] for suicidal ideation and OR, 0.60 [95% CI, 0.46-0.79] for suicide attempts).Conclusions and relevanceIn this cohort study, emerging adults who perceived higher levels of social support reported experiencing fewer mental health problems 1 year later. These findings suggest that perceived social support may protect against mental health problems during the transition into adulthood, even in those who experience mental health problems in adolescence. Leveraging social support in prevention and treatment options may protect against mental health symptoms during this transition period.

Project description:ObjectiveThis study aimed to explore the relationship between different types of interpersonal relationships and anxiety symptoms, depressive symptoms, and suicidal ideation and discusses the impact of different grades among middle school students.MethodsThe Patient Health Questionnaire Depression Scale, the Chinese version of the Generalized Anxiety Scale, suicidal ideation questions, and interpersonal relations items were used to measure the depression symptoms, anxiety symptoms, suicidal ideation, and interpersonal relations of the participants. The variables of anxiety symptoms, depressive symptoms, suicidal ideation, and interpersonal relations were screened using the Chi-square test and principal component analysis. AMOS17.0 constructs the path of the association between interpersonal relations and depressive symptoms, anxiety symptoms, and suicidal ideation.ResultsThe mother-child relationship had direct impacts of -0.06, -0.07, and -0.06 on anxiety symptoms, depressive symptoms, and suicidal ideation. On anxiety symptoms, depressive symptoms, and suicidal ideation, the direct impacts of the father-child relationship were -0.09, -0.03, and -0.08. Moreover, the direct effects of peer relationships on depressive symptoms were -0.04, whereas the direct impact of teacher-student relationships on anxiety and depressive symptoms were -0.10 and -0.09. Further pathway analysis based on grade level showed that in the junior high school model, the direct effect of the mother-child relationship on anxiety and depressive symptoms was -0.18 and -0.16. The direct impact of the father-child relationship on depressive symptoms and suicidal ideation was -0.08 and 0.09. The direct effect of peer relationships on depressive symptoms was -0.08, and the direct impact of the teacher-student relationship on anxiety symptoms was -0.06. In the high school model, the direct effect of the mother-child relationship on suicidal ideation was -0.07, while the direct impact of the father-child relationship on anxiety, depression, and suicidal ideation was -0.10, -0.07, and -0.12, respectively. In addition, the direct effects of peer relationships on anxiety and depression were -0.06 and -0.05, and the direct impact of teacher-student relationships on anxiety and depression was -0.10 and -0.11.ConclusionThe father-child relationship affects suicidal ideation and depression the most, followed by the mother-child relationship, the teacher-student interaction, and the peer relationship. The teacher-student relationship influences anxiety symptoms the most, followed by the father-child and mother-child relationships. The association between interpersonal interactions and anxiety, depressive symptoms, and suicidal ideation varied significantly across grade levels.

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Improvement in suicidal ideation after ketamine infusion: relationship to reductions in depression and anxiety.

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Improvement in suicidal ideation after ketamine infusion: relationship to reductions in depression and anxiety.

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