The Impact of Intravenous Ketamine Treatment on Sleep and Suicidal Thoughts

Authors

• AN Tillman
• D Greenstein
• N Hejazi
• L Waldman
• C Zarate
• E Ballard

Abstract

Insomnia is a suicide risk factor, and sleep disruption is associated with increased risk for death by suicide. Ketamine(0.5 mg/kg) is associated with reductions in depression, suicidal thoughts, and improved sleep. It is important to study correlates of ketamine’s impact on suicidal ideation to understand who would most benefit. Participants were recruited into a neurobiology-of-suicide study and categorized: 1)experienced a suicide crisis within two weeks(High-Risk(HR),n=14), 2)experienced a suicide crisis more than a year ago(Low-Risk(LR),n=41), 3)presence of any psychiatric diagnosis without a history of suicide(Clinical-Controls (CC)),n=39), 4)healthy volunteers(HV),n=32). Participants completed the Pittsburgh Sleep Quality-Index (PSQ-I) to measure self-reported sleep over the last month. A subsample of HR received inpatient ketamine(n=9) and completed the Hamilton Depression Rating Scale (HAM-D) pre- and post-ketamine. One way ANOVA evaluated group differences in PSQ-I global scores and post-hoc tests compared HR, LR, CC, and HV. A paired t-test assessed ketamine changes in insomnia and suicide items on the HAM-D. There were group differences in the PSQ-I(F(3,118)=29.59,p<0.005): post-hoc tests highlighted HR, LR, and CC were significantly increased compared to HV(p<0.005). HR had a trend of increased global PSQ-I scores compared to LR(p=0.057). Ketamine significantly reduced suicidal thoughts(t=2.8,p<0.05) and insomnia in the middle of the night(t=2.53,p<0.05). The findings underscore sleep disruptions as a potential risk factor for a suicide crisis and the potential for ketamine to improve suicidal thoughts and sleep. Future studies should explore interventions on suicide related sleep measures.

Scientific Focus Area: Clinical Research

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