Rapid response with ketamine on suicidal cognition in resistant depression.

CONTEXT: Suicidal ideation in depressed patients is a serious and emergent condition that requires urgent intervention. Intravenous ketamine, an N-methyl-D-aspartate (NMDA) antagonist, has shown rapid antidepressant effects, making it a potentially attractive candidate for depressed patients with suicidal risk. AIMS: In India few studies have corroborated such findings; the present study aimed to assess the effectiveness and sustainability of antisuicidal effects of ketamine in subjects with resistant depression. SETTINGS AND DESIGN: Single-center, prospective, 4 weeks, open-label, single-arm pilot study. MATERIALS AND METHODS: Twenty-seven subjects with DSM-IV major depression (treatment resistant) were recruited. The subjects were assessed on Scale for Suicidal Ideation (SSI), 17-item Hamilton Depression Rating Scale (HDRS). After a 2-week drug-free period, subjects were given a single intravenous infusion of ketamine hydrochloride (0.5 mg/kg) and were rated at baseline and at 40, 80, 120, and 230 minutes and 1 and 2 days postinfusion. RESULTS: The ketamine infusion was effective in reducing the SSI and HDRS scores, the change remained significant from minute 40 to 230 at each time point. CONCLUSIONS: The real strength of this study rests in documenting the rapid albeit short-lasting effect of ketamine on suicidal ideation in depressed patients.

Deliberate Self-harm: A Search for Distinct Group of Suicide.

OBJECTIVE: Some persons attempt suicide with a strong intention to die and some are not. Presently, no distinctive grouping has been done on the basis of the suicidal intention, though there is a significant variation in the psycho-socio-demographic profile, suicidal ideation, and intent within the persons making suicidal attempt. The aim of our study was to find the psycho-socio-demographic profile, suicide intent in survivors of suicide attempt, categorizing them by suicide intent, and finally to define the deliberate self-harm (DSH) group. MATERIALS AND METHODS: It was a cross-sectional study. Two hundred patients who survived suicide attempt were evaluated by a psychiatrist. The data were recorded for sociodemographic variables, psychiatric disorder, suicide intent, and lethality of suicide attempt. Grouping was done by using suicide intent as the determining dimension. The DSH group was defined by psycho-socio-demographic characteristics of the patient. RESULTS: The mean age of the DSH group was 26.72 years, mostly females (50.5%), semiskilled workers (43.43%) and housewives (32.32%), from nuclear family (60.6%) with no psychiatric disorder (35.35%). Most of them attempted a nonlethal suicide attempt (87.87%) by organophosphorus poisoning (87.87%). CONCLUSIONS: The DSH group is a distinct group among suicide attempters, having different psycho-socio-demographic characteristics.