Two cases of delayed-onset suicidal ideation, dysphoria and anxiety after ketamine infusion in patients with obsessive-compulsive disorder and a history of major depressive disorder

Mark J Niciu; Beth D G Grunschel; Philip R Corlett; Christopher Pittenger; Michael H Bloch

doi:10.1177/0269881113486718

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Two cases of delayed-onset suicidal ideation, dysphoria and anxiety after ketamine infusion in patients with obsessive-compulsive disorder and a history of major depressive disorder

Journal article

Peer reviewed

Two cases of delayed-onset suicidal ideation, dysphoria and anxiety after ketamine infusion in patients with obsessive-compulsive disorder and a history of major depressive disorder

Mark J Niciu, Beth D G Grunschel, Philip R Corlett, Christopher Pittenger and Michael H Bloch

Journal of psychopharmacology (Oxford), Vol.27(7), pp.651-654

07/2013

DOI: 10.1177/0269881113486718

PMID: 23676198

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Abstract

Ketamine is a non-competitive N-methyl-D-aspartate receptor antagonist that is Food and Drug Administration-approved in the United States for anesthesia due to its sedative effects with low risk of severe respiratory depression. Subanesthetic dose intravenous ketamine has rapidly acting antidepressant effects in treatment-resistant unipolar and bipolar depression. We recently reported an open-label trial of ketamine in 10 subjects with treatment-refractory obsessive-compulsive disorder, seven of whom had active comorbid depression. Although ketamine had no sustained anti-obsessive effect, four of the seven subjects with comorbid depression experienced an acute antidepressant effect. However, we unexpectedly observed delayed-onset dysphoria, worsening anxiety and suicidal thinking in two of the three subjects with obsessive-compulsive disorder and extensive psychiatric comorbidity but minimal depressive symptoms at the start of infusion. The implications of these adverse neuropsychiatric effects in two patients with similar psychiatric comorbidity are discussed. We conclude that there remains insufficient data on therapeutic ketamine in the presence of comorbid psychiatric disorders to promote its off-label use in a non-research milieu.

Ketamine - adverse effects

Obsessive-Compulsive Disorder - drug therapy

Humans

Middle Aged

Adult

Female

Suicidal Ideation

Anxiety - chemically induced

Ketamine - administration & dosage

Depressive Disorder, Major - drug therapy

Details

Title: Subtitle: Two cases of delayed-onset suicidal ideation, dysphoria and anxiety after ketamine infusion in patients with obsessive-compulsive disorder and a history of major depressive disorder
Creators: Mark J Niciu - Yale University, Department of Psychiatry/Connecticut Mental Health Center (CMHC), Clinical Neuroscience Research Unit (CNRU), New Haven, Connecticut, USA. mark.niciu@nih.gov
Beth D G Grunschel
Philip R Corlett
Christopher Pittenger
Michael H Bloch
Resource Type: Journal article
Publication Details: Journal of psychopharmacology (Oxford), Vol.27(7), pp.651-654
DOI: 10.1177/0269881113486718
PMID: 23676198
NLM abbreviation: J Psychopharmacol
ISSN: 0269-8811
eISSN: 1461-7285
Publisher: United States
Grant note: UL1RR024139 / NCRR NIH HHS T32MH19961 / NIMH NIH HHS K23MH091240-01 / NIMH NIH HHS K08MH081190 / NIMH NIH HHS
Language: English
Date published: 07/2013
Academic Unit: Psychiatry; Iowa Neuroscience Institute
Record Identifier: 9984003488502771

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