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S-Ketamine in the treatment of depressive emergencies: a cases series of patients in a suicidal crisis

Published online by Cambridge University Press:  01 September 2022

B. Baune ,
Z. Susam ,
V. Falcone ,
C. Knümann ,
P. Sarkheil  and
E. Kavakbasi
B. Baune*
Affiliation:
Westfaelische-Wilhelms-University Muenster (WWU), Department Of Mental Health, Muenster, Germany
Z. Susam
Affiliation:
University of Münster, Department Of Psychiatry, Münster, Germany
V. Falcone
Affiliation:
University of Münster, Department Of Psychiatry, Münster, Germany
C. Knümann
Affiliation:
University of Münster, Department Of Psychiatry, Münster, Germany
P. Sarkheil
Affiliation:
University of Münster, Department Of Psychiatry, Münster, Germany
E. Kavakbasi
Affiliation:
University of Münster, Department Of Psychiatry, Münster, Germany
*
*Corresponding author.

Abstract

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Introduction

Psychiatric emergencies in Major Depressive Disorder (MDD) are characterised by multiple types of symptoms including risk of self-harm and suicidal ideation. S-ketamine intranasally (Spravato) has recently been shown to help alleviate symptoms during depressive emergencies. In this case-series, we detail the clinical effects and usability of S-ketamine applied intranasally in a psychiatric emergency setting.

Objectives

To describe the effects of S-Ketamine on depressive crises associated with suicidality and self-harm in a psychiatric emergency setting.

Methods

Patients with MDD in a psychiatric emergency were provided with intranasal S-Ketamine according to clinical indication in routine clinical care in a University inpatient setting. Clinical characteristics were assessed in a standardised manner and symptom measures were applied pre-and posttreatment. Experience with 10 patients is systematically described in this case-series.

Results

Patients had a primary diagnosis of MDD accompanied by a variety of secondary psychiatric comorbidity. Among these 10 patients, the majority were female (70 %) and the mean age was 49.5 yrs (range 26-66). All cases were considered treatment resistant and suffered severe acute suicidal ideation. Across all cases, pre-treatment MADRS was 37 on average (range 20-47) indicating a severe form of MDD. High severity was confirmed in elevated BDI scores (pre-treatment 39). Post-treatment, MADRS scores were reduced to 18 on average, alongside BDI scores (mean 24). S-ketamine administration was well-tolerated and side effects such as dissociation were of short-lived duration.

Conclusions

S-Ketamine intranasally can be safely and effectively administered in an acute psychiatric setting to treat psychiatric emergencies.

Disclosure

BTB received honoraria for consultancy and presentations from AstraZeneca, Bristol-Myers Squibb, Lundbeck, Pfizer, Servier, Wyeth, LivaNova, Janssen, Novartis, Otsuka, Angelini.

Keywords

s-ketaminedepressionsuicidal ideationemergency psychiatry
Type
Abstract
Information
European Psychiatry , Volume 65 , Special Issue S1: Abstracts of the 30th European Congress of Psychiatry , June 2022 , pp. S565
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of the European Psychiatric Association
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