Ketamine augmentation for major depressive disorder and suicidal ideation: preliminary experience in an inpatient psychiatry setting

Background Ketamine is known to rapidly reduce depressive symptoms and suicidal ideation (SI) in patients with major depressive disorder (MDD), but evidence is limited for its acceptability and effectiveness in “real-world” settings. This case series examines serial ketamine infusions in reducing SI and depression scores in adults with MDD admitted to a tertiary care hospital. Methods Five inpatients with MDD and SI admitted to hospital in Toronto, Canada received six infusions of 0.5 mg/kg intravenous (IV) ketamine (n = 5) over approximately 12 days, in addition to treatment-as-usual. Suicide and depression rating scores (Scale for Suicidal Ideation, SSI; Montgomery-Åsberg Depression Rating Scale, MADRS) were obtained at baseline, on treatment days, on days 14 and 42 (primary endpoint). Results All patients experienced benefit with ketamine. SSI scores diminished by 84% from 14.0 ± 4.5 at baseline to 2.2 ± 2.5 at study endpoint. MADRS scores diminished by 47% from 42.2 ± 5.3 at baseline to 22.4 ± 8.0. Two patients withdrew from the study, one to initiate electroconvulsive therapy and one due to an adverse event (dissociative effects) during the ketamine infusion. Limitations The major limitation of this study is the small sample size. Discussion These preliminary pilot data are promising with a greater than two-fold reduction in SI following ketamine infusions. They demonstrate that six serial ketamine infusions may be safe and feasible. These findings support the need for large scale randomized controlled trials to confirm the efficacy of serial ketamine for treatment of SI in “real-world” setting

Additional file 1: Table S1. of KCa1.1, a calcium-activated potassium channel subunit alpha 1, is targeted by miR-17-5p and modulates cell migration in malignant pleural mesothelioma

Top 20 Enriched microRNA Families Extracted from the Four Gene Expression Datasets. Table S2. Pathway Enrichment Analysis of Gene Targets of the miR-17 family members. Table S3. Primers and TaqMan Assay IDs for RT-qPCR and siRNA and Mimic Sequences. Table S4. Characteristics of Patients Analyzed in Fig. 2h and i. Table S5. Individual P values for Fig. 3a, f and g. Figure S1. TGFBR2 mRNA down regulated followed miR-17-5p transfection. Figure S2. MPM cell viability was not affected by transfection with miR-17-5p mimic or siRNA. Figure S3. Effect of KCNMA1 down-regulation on cell cycle in MPM cells. Figure S4. KCNMA1 down-regulation and miR-17-5p did not induce MPM cell apoptosis. Figure S5. Migration of MPM cell lines treated with miR-17-5p mimic or KCNMA1 siRNAs. Figure S6. Invasion of MPM cell lines treated with miR-17-5-5p mimic or KCNMA1 siRNAs. Figure S7. Paxilline did not sensitize MPM cells to cisplatin or gemcitabine. (DOCX 10063 kb