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Ketamine for rapid reduction of suicidal ideation: a randomized controlled trial
- J. W. Murrough, L. Soleimani, K. E. DeWilde, K. A. Collins, K. A. Lapidus, B. M. Iacoviello, M. Lener, M. Kautz, J. Kim, J. B. Stern, R. B. Price, A. M. Perez, J. W. Brallier, G. J. Rodriguez, W. K. Goodman, D. V. Iosifescu, D. S. Charney
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- Journal:
- Psychological Medicine / Volume 45 / Issue 16 / December 2015
- Published online by Cambridge University Press:
- 12 August 2015, pp. 3571-3580
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Background.
Suicide is a devastating public health problem and very few biological treatments have been found to be effective for quickly reducing the intensity of suicidal ideation (SI). We have previously shown that a single dose of ketamine, a glutamate N-methyl-d-aspartate (NMDA) receptor antagonist, is associated with a rapid reduction in depressive symptom severity and SI in patients with treatment-resistant depression.
Method.We conducted a randomized, controlled trial of ketamine in patients with mood and anxiety spectrum disorders who presented with clinically significant SI (n = 24). Patients received a single infusion of ketamine or midazolam (as an active placebo) in addition to standard of care. SI measured using the Beck Scale for Suicidal Ideation (BSI) 24 h post-treatment represented the primary outcome. Secondary outcomes included the Montgomery–Asberg Depression Rating Scale – Suicidal Ideation (MADRS-SI) score at 24 h and additional measures beyond the 24-h time-point.
Results.The intervention was well tolerated and no dropouts occurred during the primary 7-day assessment period. BSI score was not different between the treatment groups at 24 h (p = 0.32); however, a significant difference emerged at 48 h (p = 0.047). MADRS-SI score was lower in the ketamine group compared to midazolam group at 24 h (p = 0.05). The treatment effect was no longer significant at the end of the 7-day assessment period.
Conclusions.The current findings provide initial support for the safety and tolerability of ketamine as an intervention for SI in patients who are at elevated risk for suicidal behavior. Larger, well-powered studies are warranted.
Contributors
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- By Shamsuddin Akhtar, Greg Albert, Sidney Allison, Muhammad Anwar, Haruo Arita, Amanda Barker, Mary Hanna Bekhit, Jeanna Blitz, Tyson Bolinske, David Burbulys, Asokumar Buvanendran, Gregory Cain, Keith A. Candiotti, Daniel B. Carr, Derek Chalmers, John Charney, Rex Cheng, Roger Chou, Keun Sam Chung, Anna Clebone, Frederick Conlin, Susan Dabu-Bondoc, Tiffany Denepitiya-Balicki, Jeanette Derdemezi, Anahat Kaur Dhillon, Ho Dzung, Juan Jose Egas, Stephen M. Eskaros, Zhuang T. Fang, Claudia R. Fernandez Robles, Victor A. Filadora, Ellen Flanagan, Dan Froicu, Allison Gandey, Nehal Gatha, Boris Gelman, Christopher Gharibo, Muhammad K. Ghori, Brian Ginsberg, Michael E. Goldberg, Jeff Gudin, Thomas Halaszynski, Martin Hale, Dorothea Hall, Craig T. Hartrick, Justin Hata, Lars E. Helgeson, Joe C. Hong, Richard W. Hong, Balazs Horvath, Eric S. Hsu, Gabriel Jacobs, Jonathan S. Jahr, Rongjie Jaing, Inderjeet Singh Julka, Zeev N. Kain, Clinton Kakazu, Kianusch Kiai, Mary Keyes, Michael M. Kim, Peter G. Lacouture, Ryan Lanier, Vivian K. Lee, Mark J. Lema, Oscar A. de Leon-Casasola, Imanuel Lerman, Philip Levin, Steven Levin, JinLei Li, Eric C. Lin, Sharon Lin, David A. Lindley, Ana M. Lobo, Marisa Lomanto, Mirjana Lovrincevic, Brenda C. McClain, Tariq Malik, Jure Marijic, Joseph Marino, Laura Mechtler, Alan Miller, Carly Miller, Amit Mirchandani, Sukanya Mitra, Fleurise Montecillo, James M. Moore, Debra E. Morrison, Philip F. Morway, Carsten Nadjat-Haiem, Hamid Nourmand, Dana Oprea, Sunil J. Panchal, Edward J. Park, Kathleen Ji Park, Kellie Park, Parisa Partownavid, Akta Patel, Bijal Patel, Komal D. Patel, Neesa Patel, Swati Patel, Paul M. Peloso, Danielle Perret, Anthony DePlato, Marjorie Podraza Stiegler, Despina Psillides, Mamatha Punjala, Johan Raeder, Siamak Rahman, Aziz M. Razzuk, Maggy G. Riad, Kristin L. Richards, R. Todd Rinnier, Ian W. Rodger, Joseph Rosa, Abraham Rosenbaum, Alireza Sadoughi, Veena Salgar, Leslie Schechter, Michael Seneca, Yasser F. Shaheen, James H. Shull, Elizabeth Sinatra, Raymond S. Sinatra, Neil Singla, Neil Sinha, Denis V. Snegovskikh, Dmitri Souzdalnitski, Julie Sramcik, Zoreh Steffens, Alexander Timchenko, Vadim Tokhner, Marc C. Torjman, Co T. Truong, Nalini Vadivelu, Ashley Vaughn, Anjali Vira, Eugene R. Viscusi, Dajie Wang, Shu-ming Wang, J. Michael Watkins-Pitchford, Steven J. Weisman, Ira Whitten, Bryan S. Williams, Jeremy M. Wong, Thomas Wong, Christopher Wray, Yaw Wu, Anthony T. Yarussi, Laurie Yonemoto, Bita H. Zadeh, Jill Zafar, Martha Zegarra, Keren Ziv
- Edited by Raymond S. Sinatra, Jonathan S. Jahr, University of California, Los Angeles, School of Medicine, J. Michael Watkins-Pitchford
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- Book:
- The Essence of Analgesia and Analgesics
- Published online:
- 06 December 2010
- Print publication:
- 14 October 2010, pp xi-xviii
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Contributors
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- By Jon G. Allen, Robert F Anda, Susan L. Andersen, Carl M. Anderson, Wendy d’ Andrea, Tal Astrachan, Anthony W. Bateman, Carla Bernardes, Renato Borgatti, Bekh Bradley, J. Douglas Bremner, John Briere, Amy F. Buckley, Jean-Francois Bureau, Kathleen M. Chard, Dennis Charney, Anthony Charuvastra, Jeewook Choi, Marylene Cloitre, Melody D. Combs, Constance J. Dalenberg, Martin J. Dorahy, Michael D. De Bellis, Anne P. DePrince, Erin C. Dunn, Vincent J. Felitti, Philip A. Fisher, Peter Fonagy, Julian D. Ford, Amit Goldenberg, Megan R. Gunnar, Udi Harari, Felicia Heidenreich, Christine Heim, Judith Herman MD, Monica Hodges, Shlomit Jacobson-Pick, Joan Kaufman, Karestan C. Koenen, Ruth A. Lanius, Jamie L. LaPrairie, Alicia F. Lieberman, Richard J. Loewenstein, Sonia J. Lupien MD, Karlen Lyons-Ruth, Jodi Martin, Bruce McEwen, Alexander C. McFarlane, Rosario Montirosso, Charles B. Nemeroff, Pat Ogden, Fatih Ozbay, Clare Pain, Kelsey Paulson, Oxana G. Palesh, Ms. Keren Rabi, Gal Richter-Levin, Andrea L. Roberts, Cécile Rousseau, Cécile Rousseau, Monica Ruiz-Casares, Christian Schmahl, Allan N. Schore, Sally B. Seraphin, Vansh Sharma, Yi-Shin Sheu, Kelly Skelton, Steven Southwick, David Spiegel, Deborah M. Stone, Nathan Szajnberg, Martin H. Teicher, Akemi Tomoda, Ed Tronick, Onno van der Hart, Bessel van der Kolk, Eric Vermetten, Tamara Weiss, Victor Welzant
- Edited by Ruth A. Lanius, University of Western Ontario, Eric Vermetten, Universiteit Utrecht, The Netherlands, Clare Pain, University of Toronto
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- Book:
- The Impact of Early Life Trauma on Health and Disease
- Published online:
- 03 May 2011
- Print publication:
- 05 August 2010, pp vii-xii
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Biased emotional attention in post-traumatic stress disorder: a help as well as a hindrance?
- M. VYTHILINGAM, K. S. BLAIR, D. McCAFFREY, M. SCARAMOZZA, M. JONES, M. NAKIC, K. MONDILLO, K. HADD, O. BONNE, D. G. V. MITCHELL, D. S. PINE, D. S. CHARNEY, R. J. R. BLAIR
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- Journal:
- Psychological Medicine / Volume 37 / Issue 10 / October 2007
- Published online by Cambridge University Press:
- 11 June 2007, pp. 1445-1455
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Background
From a cognitive neuroscience perspective, the emotional attentional bias in post-traumatic stress disorder (PTSD) could be conceptualized either as emotional hyper-responsiveness or as reduced priming of task-relevant representations due to dysfunction in ‘top-down’ regulatory systems. We investigated these possibilities both with respect to threatening and positive stimuli among traumatized individuals with and without PTSD.
MethodTwenty-two patients with PTSD, 21 trauma controls and 20 non-traumatized healthy participants were evaluated on two tasks. For one of these tasks, the affective Stroop task (aST), the emotional stimuli act as distracters and interfere with task performance. For the other, the emotional lexical decision task (eLDT), emotional information facilitates task performance.
ResultsCompared to trauma controls and healthy participants, patients with PTSD showed increased interference for negative but not positive distracters on the aST and increased emotional facilitation for negative words on the eLDT.
ConclusionsThese findings document that hyper-responsiveness to threat but not to positive stimuli is specific for patients with PTSD.
Looking Backward, Looking Forward: MLA Members Speak
- April Alliston, Elizabeth Ammons, Jean Arnold, Nina Baym, Sandra L. Beckett, Peter G. Beidler, Roger A. Berger, Sandra Bermann, J.J. Wilson, Troy Boone, Alison Booth, Wayne C. Booth, James Phelan, Marie Borroff, Ihab Hassan, Ulrich Weisstein, Zack Bowen, Jill Campbell, Dan Campion, Jay Caplan, Maurice Charney, Beverly Lyon Clark, Robert A. Colby, Thomas C. Coleman III, Nicole Cooley, Richard Dellamora, Morris Dickstein, Terrell Dixon, Emory Elliott, Caryl Emerson, Ann W. Engar, Lars Engle, Kai Hammermeister, N. N. Feltes, Mary Anne Ferguson, Annie Finch, Shelley Fisher Fishkin, Jerry Aline Flieger, Norman Friedman, Rosemarie Garland-Thomson, Sandra M. Gilbert, Laurie Grobman, George Guida, Liselotte Gumpel, R. K. Gupta, Florence Howe, Cathy L. Jrade, Richard A. Kaye, Calhoun Winton, Murray Krieger, Robert Langbaum, Richard A. Lanham, Marilee Lindemann, Paul Michael Lützeler, Thomas J. Lynn, Juliet Flower MacCannell, Michelle A. Massé, Irving Massey, Georges May, Christian W. Hallstein, Gita May, Lucy McDiarmid, Ellen Messer-Davidow, Koritha Mitchell, Robin Smiles, Kenyatta Albeny, George Monteiro, Joel Myerson, Alan Nadel, Ashton Nichols, Jeffrey Nishimura, Neal Oxenhandler, David Palumbo-Liu, Vincent P. Pecora, David Porter, Nancy Potter, Ronald C. Rosbottom, Elias L. Rivers, Gerhard F. Strasser, J. L. Styan, Marianna De Marco Torgovnick, Gary Totten, David van Leer, Asha Varadharajan, Orrin N. C. Wang, Sharon Willis, Louise E. Wright, Donald A. Yates, Takayuki Yokota-Murakami, Richard E. Zeikowitz, Angelika Bammer, Dale Bauer, Karl Beckson, Betsy A. Bowen, Stacey Donohue, Sheila Emerson, Gwendolyn Audrey Foster, Jay L. Halio, Karl Kroeber, Terence Hawkes, William B. Hunter, Mary Jambus, Willard F. King, Nancy K. Miller, Jody Norton, Ann Pellegrini, S. P. Rosenbaum, Lorie Roth, Robert Scholes, Joanne Shattock, Rosemary T. VanArsdel, Alfred Bendixen, Alarma Kathleen Brown, Michael J. Kiskis, Debra A. Castillo, Rey Chow, John F. Crossen, Robert F. Fleissner, Regenia Gagnier, Nicholas Howe, M. Thomas Inge, Frank Mehring, Hyungji Park, Jahan Ramazani, Kenneth M. Roemer, Deborah D. Rogers, A. LaVonne Brown Ruoff, Regina M. Schwartz, John T. Shawcross, Brenda R. Silver, Andrew von Hendy, Virginia Wright Wexman, Britta Zangen, A. Owen Aldridge, Paula R. Backscheider, Roland Bartel, E. M. Forster, Milton Birnbaum, Jonathan Bishop, Crystal Downing, Frank H. Ellis, Roberto Forns-Broggi, James R. Giles, Mary E. Giles, Susan Blair Green, Madelyn Gutwirth, Constance B. Hieatt, Titi Adepitan, Edgar C. Knowlton, Jr., Emanuel Mussman, Sally Todd Nelson, Robert O. Preyer, David Diego Rodriguez, Guy Stern, James Thorpe, Robert J. Wilson, Rebecca S. Beal, Joyce Simutis, Betsy Bowden, Sara Cooper, Wheeler Winston Dixon, Tarek el Ariss, Richard Jewell, John W. Kronik, Wendy Martin, Stuart Y. McDougal, Hugo Méndez-Ramírez, Ivy Schweitzer, Armand E. Singer, G. Thomas Tanselle, Tom Bishop, Mary Ann Caws, Marcel Gutwirth, Christophe Ippolito, Lawrence D. Kritzman, James Longenbach, Tim McCracken, Wolfe S. Molitor, Diane Quantic, Gregory Rabassa, Ellen M. Tsagaris, Anthony C. Yu, Betty Jean Craige, Wendell V. Harris, J. Hillis Miller, Jesse G. Swan, Helene Zimmer-Loew, Peter Berek, James Chandler, Hanna K. Charney, Philip Cohen, Judith Fetterley, Herbert Lindenberger, Julia Reinhard Lupton, Maximillian E. Novak, Richard Ohmann, Marjorie Perloff, Mark Reynolds, James Sledd, Harriet Turner, Marie Umeh, Flavia Aloya, Regina Barreca, Konrad Bieber, Ellis Hanson, William J. Hyde, Holly A. Laird, David Leverenz, Allen Michie, J. Wesley Miller, Marvin Rosenberg, Daniel R. Schwarz, Elizabeth Welt Trahan, Jean Fagan Yellin
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- Journal:
- PMLA / Publications of the Modern Language Association of America / Volume 115 / Issue 7 / December 2000
- Published online by Cambridge University Press:
- 23 October 2020, pp. 1986-2078
- Print publication:
- December 2000
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6 - Predictability of monsoons
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- By J. G. Charney, Department of Meteorology, Massachusetts Institute of Technology, J. Shukla, Department of Meteorology, Massachusetts Institute of Technology
- James Lighthill, R. P. Pearce
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- Book:
- Monsoon Dynamics
- Published online:
- 05 November 2011
- Print publication:
- 19 March 1981, pp 99-110
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Summary
It is shown by numerical simulation that the variability of average pressure and rainfall for July due to short-period flow instabilities occurring in the absence of boundary anomalies can account for most of the observed variability at midlatitudes but not at low latitudes. On the basis of the available evidence it is suggested that a large part of the low-latitude variability is due to boundary anomalies in such quantities as sea-surface temperature, albedo and soil moisture, which, having longer time constants, are more predictable than the flow instabilities. Additional variability due to long-period natural fluctuations would likewise be more predictable.
The degree of predictability of monsoons is a matter of considerable social and economic importance. Large agrarian populations exist in monsoon areas, and monsoon rains have a critical influence on food production and human welfare. The long-range prediction of average rainfall could be of immense value for water management and agricultural planning. In this chapter, evidence that mean flow conditions and precipitation patterns at low latitudes are in principle more predictable than those at high latitudes is presented. Among the low-latitude circulations are the African and Asian monsoons and perhaps also the southeasterly monsoon flow east of the North American Cordillera. In particular we wish to show that the natural flow instabilities on synoptic scales account for most of the interannual variability of monthly mean quantities at midlatitudes, but cannot explain the observed variability at low latitudes.