Initiating Ketamine in Acutely Suicidal Patients in the Emergency Department

Publication date: Feb 07, 2020

Current treatment for acutely suicidal patients are limited to hospitalization, psychotherapy, electro-convulsant therapy, or a combination of the aforementioned. However, this has added to the national boarding problem. Long term pharmacologic treatment for suicidal behaviors and mood stabilization has been studied in specific populations. In these populations, the decreases in suicidal ideation results from stabilization of the underlying psychiatric illness. Ketamine is most commonly used as an anesthetic with analgesic properties. It has been used off-label for pain management, procedural sedation, status epilepticus, and treatment resistant depression. It has been safely administered intravenously and well tolerated for chronic Post Traumatic Stress Disorder. It increases norepinephrine, dopamine, and serotonin through adrenergic neuron stimulation and prevention of catecholamine uptake. There is a strong corollary between stress and the development of depression and suicidal behaviors. It is proposed that the use of low dose intravenous ketamine may have benefit on the suicidal ideation of patients presenting to the Emergency Department.

Concepts Keywords
Adrenergic Depression treatment
Analgesic Median eminence systems
Anesthetic Similar protocol
Anterior Cingulate Pain
Anterior Cingulate Cortex Resistant depression
Antidepressant Psychiatric disorders depression
Axis Pain management
BDNF Deep brain stimulation
Biomarker Psychotherapy
Biomarkers Psychoactive drugs
Camp Lejeune Neurochemistry
Catecholamine RTT
Central Nervous System Antidepressants
Clinical Trial Depression
Clinical Trials Amines
Cognitive Disorder Chloroarenes
Cognitive Flexibility Ketamine
Convulsant Suicide
Cortical Management of depression
Corticotropin Releasing Factor Suicidal ideation
Deep Brain Stimulation 35 protocol
Depression
Dopamine
ED50
Electro
Emergency Department
Excitatory
Glucose
Gold Standard
Hamilton
Impulsivity
Infusion
Interrater Reliability
Intranasal Administration
Intravenous
Intravenously
Iran
Ketamine
Locus
Long Term Potentiation
Median Eminence
Metabolism
Metabolite
Montgomery
Mood Disorder
Mood Disorders
Narcosis
Neurobiological
Neuroimaging
Neuron
Neuronal Plasticity
Neurons
NMDA
NMDA Antagonists
Noradrenergic
Norepinephrine
Nursing
Nystagmus
Pain
Pain Management
Pharmacologic
Physician
Placebo
Prefrontal Cortex
Primary Producer
Protocol
Psychiatric Disorders
Psychiatric Illness
Psychosis
Psychotherapy
Receptors
Saline
Schizophrenia
Serotonergic
Serotonin
Serotonin Transporter
Sleep
Status Epilepticus
Stress
Suicidal Ideation
Suicidal Thoughts
Suicide
Synaptic
Synaptic Plasticity
Synchronization
Treatment Modality
Treatment Resistant Depression
Ventromedial Prefrontal Cortex

Semantics

Type Source Name
drug DRUGBANK Ketamine
disease MESH Emergency
disease MESH suicidal ideation
disease MESH psychiatric illness
disease MESH status epilepticus
disease MESH treatment resistant depression
disease MESH chronic Post Traumatic Stress Disorder
drug DRUGBANK Norepinephrine
drug DRUGBANK Dopamine
drug DRUGBANK Serotonin
disease MESH development
disease MESH depression
disease MESH military personnel
disease MESH psychosis
disease MESH Schizophrenia
drug DRUGBANK Cyclic Adenosine Monophosphate

Original Article

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