Early improvement after ketamine or esketamine may predict fewer suicide-associated emergency department visits in .
Evidence
This retrospective cohort study followed 96 patients with treatment-resistant depression and SI data for 6 months, with a secondary IV ketamine analysis showing adjusted lower SAED-visit odds after early SI reduction.
Caveat
Several main comparisons were trends or not statistically significant, and the retrospective sample was small, especially for post-acute SAED events.
Simplified
BACKGROUND: Ketamine and esketamine ((es)ketamine) rapidly reduce depressive symptoms and (SI) in (TRD), but whether early SI improvement during the acute phase of the treatment predicts reduced suicide-associated emergency department (SAED) visits over the longer term remains unclear.
OBJECTIVES: To examine whether early improvements in SI, measured using item 12 of the Quick Inventory of Depressive Symptomatology - Self Reported (QIDS-SR), following (es)ketamine treatment are associated with SAED visits over 6 months.
DESIGN: Retrospective cohort study.
METHODS: Individuals with TRD who had available data on SI measured using the QIDS-SR during the acute phase, as well as data on SAED visits over 6 months, were included. Participants were classified based on changes in SI as resolved, partially improved, or unchanged/worsened using the QIDS-SR item 12 during acute treatment (up to six intravenous (IV) or eight intranasal (IN) treatments) and were followed for SAED visits.
RESULTS: Among 96 patients with SI data, 73 (76%) had baseline SI. Following acute-phase treatment, 36 (49%) achieved SI resolution, 14 (19%) partially improved, and 23 (32%) were unchanged/worsened. During the 6-month follow-up, 8 (11%) had post-acute SAED visits. While not statistically significant, patients with resolved SI had lower odds of post-acute visits (OR = 0.16, = 0.12). Kaplan-Meier estimates of SAED visit-free survival across three SI change groups trended toward significance ( = 0.066), suggesting lower cumulative healthcare (ED) utilization in more favorable change groups. Secondary analysis among 57 patients who received IV ketamine and had baseline SI showed that, after two infusions, 33 (47.2%) demonstrated a reduction in SI. Early SI improvement (⩾50% reduction in SI) was associated with a lower likelihood of any post-treatment SAED visit at 6 months after adjusting for pre-treatment SAED (OR = 0.17, 95% CI: 0.02-0.98, = 0.047), corresponding to numbers needed to treat of 4.3. p p p
CONCLUSION: Early SI changes may have prognostic implications, though larger studies are needed to confirm clinical significance.
Key numbers
36 of 73
Reduction in
Patients with baseline who resolved after acute-phase treatment.
OR = 0.10
Lower Odds of Visits
Odds ratio for any post-acute visit among resolved patients.
OR = 0.17
Early Improvement Impact
Odds ratio for post-treatment visits with early improvement.
Full Text
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During the preparation of this manuscript, the authors used open AI ChatGPT 5 to edit and condense text. After using this tool, the authors reviewed and modified the content as pertinent and take full responsibility for the content of the manuscript.Dr. Singh has received research grant support from Mayo Clinic, the National Network of Depression Centers (NNDC), Breakthrough Discoveries for Thriving with Bipolar Disorder (BD2) and NIH. He is a KL2 Mentored Career Development Program scholar, supported by CTSA Grant Number KL2 TR002379 from the National Center for Advancing Translational Science (NCATS). Dr. Singh has received honoraria (to institution) from Elsevier for editing a Clinical Overview on Treatment-Resistant Depression. Dr Vande Voort has received a grant-in-kind for supplies and genotyping from Assurex Health, Inc. Dr Kung received an honorarium for a video-recorded CME presentation about transcranial magnetic stimulation (TMS) from Psychopharmacology Institute, a for-profit CME organization. He currently receives research support from Abbott Neuromodulation for a deep brain stimulation for depression research study, and in-kind equipment and software support for a TMS for long COVID research study. Other authors report no potential conflicts of interests.
