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Effects of melancholic features on positive and negative suicidal ideation in patients with treatment-resistant depression and strong suicidal ideation receiving low-dose ketamine infusion

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Abstract

The role of melancholic features on the antisuicidal effect of 0.5 mg/kg ketamine infusion has remained unclear in patients with treatment-resistant depression (TRD) and strong suicidal ideation (SI). Whether ketamine diminishes suicidal ideation in patients with TRD-SI was also unknown. We enrolled 84 patients with TRD-SI, including 27 with melancholic features and 57 without, and then randomly administered a single infusion of 0.5 mg/kg ketamine or 0.045 mg/kg midazolam. The clinician-rated Montgomery–Åsberg Depression Rating Scale (MADRS) item 10, Columbia Suicide Severity Rating Scale–Ideation Severity Subscale (CSSRS-ISS), and self-reported Positive and Negative Suicide Ideation Inventory (PANSI) were used to assess suicidal symptoms from baseline to day 7. Generalized estimating equation models showed that only patients without melancholic features (MADRS item 10: infusion group effect, p = 0.017; CSSRS-ISS: infusion group × time effect, p = 0.008; PANSI-negative suicidal ideation: infusion group effect, p = 0.028) benefited from the antisuicidal effect of low-dose ketamine. The PANSI-positive ideation scores were higher in the ketamine group than in the midazolam group (p = 0.038) for patients with melancholic features. Additional studies are necessary to clarify the neuromechanisms underlying the ketamine-related positive effect against SI and antisuicidal effects among patients with TRD-SI. Additional studies are necessary to clarify the neuromechanisms underlying the ketamine-related positive effect against SI and antisuicidal effects among patients with TRD-SI.

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Acknowledgements

The authors thank all research assistants, physicians, pharmacist and nursing staffs at D020 Unit of Department of Psychiatry, Taipei Veterans General Hospital and at Department of Psychiatry, Cheng Hsin General Hospital for their assistance during the study process, without whom this work could have been possible. We thank Mr I-Fan Hu for his support and friendship.

Funding

The study was supported by grant from Taipei Veterans General Hospital (V111C-010, V111C-040, V111C-029, V112C-033), Yen Tjing Ling Medical Foundation (CI-109–21, CI-109–22, CI-110–30), Kun-Po Soo Medical Foundation, Ministry of Science and Technology, Taiwan (MOST110-2314-B-075–026, MOST110-2314-B-075–024 -MY3, MOST 109–2314-B-010–050-MY3, MOST111-2314-B-075 -014 -MY2, MOST 111–2314-B-075 -013), Taipei, Taichung, Kaohsiung Veterans General Hospital, Tri-Service General Hospital, Academia Sinica Joint Research Program (VTA112-V1-6–1) and Veterans General Hospitals and University System of Taiwan Joint Research Program (VGHUST112-G1-8–1). The funding source had no role in any process of our study.

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Authors and Affiliations

  1. Department of Psychiatry, Taipei Veterans General Hospital, No. 201, Sec.2, Shih-Pai Road, Beitou District, Taipei, 112, Taiwan

    Mu-Hong Chen, Tung-Ping Su, Cheng-Ta Li, Wei-Chen Lin, Hui-Ju Wu, Shih-Jen Tsai, Ya-Mei Bai & Pei-Chi Tu

  2. Division of Psychiatry, Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan

    Mu-Hong Chen, Tung-Ping Su, Cheng-Ta Li, Wei-Chen Lin, Shih-Jen Tsai, Ya-Mei Bai & Pei-Chi Tu

  3. Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan

    Tung-Ping Su & Pei-Chi Tu

  4. Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan

    Mu-Hong Chen, Tung-Ping Su, Cheng-Ta Li, Wei-Chen Lin, Shih-Jen Tsai & Ya-Mei Bai

  5. Department of Psychiatry, Cheng Hsin General Hospital, Taipei, Taiwan

    Tung-Ping Su & Wei-Chung Mao

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  1. Mu-Hong Chen
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Chen, MH., Su, TP., Li, CT. et al. Effects of melancholic features on positive and negative suicidal ideation in patients with treatment-resistant depression and strong suicidal ideation receiving low-dose ketamine infusion. Eur Arch Psychiatry Clin Neurosci (2023). https://doi.org/10.1007/s00406-023-01735-2

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