Study of IV Ketamine for Emergency Department Treatment of Adolescent Suicidal Ideation

• Status: Not yet recruiting
• Trial end date: 2024-07-01
• Target enrollment: 0
• Participant gender: All

Summary

Approximately 20% of Canadian adolescents experience thoughts of suicide, or suicidal ideation (SI), and suicide is the second leading cause of death among Canadians aged 15-19 years. The emergency department at CHEO sees approximately four patients per day with SI. Even though this is a medical emergency, there are no fast-acting treatments available.

Ketamine is a medication that is commonly used to safely sedate children who require painful procedures in the emergency department. For nearly ten years, intravenous ketamine has also been shown to rapidly reduce SI in adults. However, ketamine as a treatment for SI has never been studied in adolescents. The primary study objective is to pilot a clinical trial that investigates intravenous ketamine to emergently treat SI in adolescents.

If intravenous ketamine can relieve symptoms of SI for youth, this would have tremendous effects on patients and would dramatically change how physicians treat adolescent mental health emergencies. If ketamine is effective for several weeks, as it is in adults, it will help temporize patients until they receive more long-term psychiatric care. At the system level, it has the potential to reduce emergency visits and lengthy admissions. The investigators feel that the results of this study will be generalizable to pediatric centres across Canada and beyond.

• Phase: Phase 4
• Accepts Healthy Volunteers?: No

Details

• Lead Sponsor: University of Ottawa
• Treatments: Ketamine

Criteria

Inclusion Criteria

1. Responds "yes" to ASQ questionnaire at triage, which asks; "Are you having thoughts of killing yourself right now?"

2. Moderate to severe suicidal ideation, defined as score ≥ 3 on the first 5 questions of the Beck Scale for Suicidal Ideation (SSI5)

3. Age 12 to 17 years, inclusive

4. Medically clear, as judged by the treating physician

5. Speaks English or French

Exclusion Criteria

1. Acute intoxication

2. Previously enrolled in the current study or another clinical trial

3. History of intellectual disability or autism spectrum disorder by patient/parent report

4. Active, or history of, psychosis or psychotic disorder

5. History of non-psychiatric neurologic disorder (e.g., epilepsy)

6. Any of the following contraindications to ketamine based on the drug monograph:

1. Known allergy or hypersensitivity to ketamine by patient history

2. History of cerebrovascular accident (stroke or aneurysm)

3. History of elevated intracranial pressure or idiopathic intracranial hypertension

4. Significant hypertension requiring daily medication

5. Severe cardiac decompensation

7. On a Form 1

8. Requires physical or chemical restraint

9. History of violence while in hospital

10. Assessment by a mental health practitioner during the current ED visit prior to study enrollment

11. Pregnant or breastfeeding