OBJECTIVE Suicide is a psychiatric emergency. Currently, there are no approved pharmacologic treatments for suicidal ideation. Ketamine is an N-methyl-D-aspartate (NMDA) receptor antagonist that rapidly reduces suicidal ideation as well as depression and anxiety, but the dynamic between these symptoms is not known. The aim of this analysis was to evaluate whether ketamine has an impact on suicidal thoughts, independent of depressive and anxiety symptoms. METHODS 133 patients with treatment-resistant depression (major depressive disorder or bipolar I/II disorder) received a single subanesthetic infusion of ketamine (0.5 mg/kg over 40 min). Post-hoc correlations and linear mixed models evaluated the relationship between suicidal ideation and depression and anxiety symptoms using the Hamilton Depression Rating Scale (HAMD), Scale for Suicidal Ideation (SSI), Beck Depression Inventory (BDI), and Hamilton Anxiety Rating Scale (HAMA) focusing on 230 min post-infusion. RESULTS At 230 min post-infusion, correlations between changes in suicidal ideation and depression ranged from 0.23 to 0.44 (p < .05), accounting for up to 19% in the variance of ideation change. Correlations with anxiety ranged from 0.23 to 0.40 (p < .05), accounting for similar levels of variance. Ketamine infusion was associated with significant reductions in suicidal ideation compared to placebo, when controlling for the effects of ketamine on depression (F1,587 = 10.31, p = .001) and anxiety (F1,567 = 8.54, p = .004). CONCLUSIONS Improvements in suicidal ideation after ketamine infusion are related to, but not completely driven by, improvements in depression and anxiety. Investigation of the specific effects of ketamine on suicidal thoughts is warranted.

中文翻译：

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氯胺酮输注后自杀意念的改善：与抑郁和焦虑减少的关系。

目的 自杀是一种精神急症。目前，没有批准的药物治疗自杀意念。氯胺酮是一种 N-甲基-D-天冬氨酸 (NMDA) 受体拮抗剂，可迅速减少自杀意念以及抑郁和焦虑，但这些症状之间的动态关系尚不清楚。这项分析的目的是评估氯胺酮是否对自杀念头有影响，独立于抑郁和焦虑症状。方法 133 名患有难治性抑郁症（重度抑郁症或双相 I/II 型障碍）的患者接受了单次亚麻醉剂氯胺酮输注（0.5 毫克/千克，持续 40 分钟）。事后相关性和线性混合模型使用汉密尔顿抑郁量表 (HAMD) 评估了自杀意念与抑郁和焦虑症状之间的关系，自杀意念量表 (SSI)、贝克抑郁量表 (BDI) 和汉密尔顿焦虑量表 (HAMA) 侧重于输注后 230 分钟。结果 输注后 230 分钟，自杀意念变化与抑郁之间的相关性范围为 0.23 至 0.44 (p < .05)，占意念变化方差的比例高达 19%。与焦虑的相关性范围从 0.23 到 0.40 (p < .05)，解释了相似的方差水平。当控制氯胺酮对抑郁 (F1,587 = 10.31, p = .001) 和焦虑 (F1,567 = 8.54, p = .004) 的影响时，与安慰剂相比，注射氯胺酮与自杀意念显着降低有关。结论 氯胺酮输注后自杀意念的改善与抑郁和焦虑的改善有关，但不完全由抑郁和焦虑的改善驱动。