Initiating Ketamine in Acutely Suicidal Patients in the Emergency Department
Status:
Enrolling by invitation
Trial end date:
2022-01-14
Target enrollment:
Participant gender:
Summary
Current treatment for acutely suicidal patients are limited to hospitalization,
psychotherapy, electro-convulsant therapy, or a combination of the aforementioned. However,
this has added to the national boarding problem. Long term pharmacologic treatment for
suicidal behaviors and mood stabilization has been studied in specific populations. In these
populations, the decreases in suicidal ideation results from stabilization of the underlying
psychiatric illness. Ketamine is most commonly used as an anesthetic with analgesic
properties. It has been used off-label for pain management, procedural sedation, status
epilepticus, and treatment resistant depression. It has been safely administered
intravenously and well tolerated for chronic Post Traumatic Stress Disorder. It increases
norepinephrine, dopamine, and serotonin through adrenergic neuron stimulation and prevention
of catecholamine uptake. There is a strong corollary between stress and the development of
depression and suicidal behaviors. It is proposed that the use of low dose intravenous
ketamine may have benefit on the suicidal ideation of patients presenting to the Emergency
Department.