Q: Which of the following drug is found to be effective in treatment of acute suicidial ideation, and may be more quicker in response to electroconvulsive therapy (ECT)?


A) Propofol
B) Ketamine
C) Haloperidol
D) Cisatracurium
E) Prozac (fluoxetine)


Answer: B

Oral antidepressants have delayed therapeytic effect and may not be ideal in the treatment of acute suicidal ideation (Choice E). Ketamine has been used as off label for this purpose in Emergency Room or intensive care setting. Ketamine is relatively short but a rapidly acting drug, found to be quicker in action even more than ECT. Due to its side effect it should be used judiciously and under close supervision. A single dose is usually sufficient and can be given intravenously at a dose of 0.5 mg/Kg. It probably works due to its dissociative property.

Propofol (Choice A) may be used as a sedative and may avert the acute situation, but has no direct role. Haloperidol (Choice C) is an anti-psychotic with role in delirium but not an antidepressive. Cisatracurium (Choice D) is a neuromuscular blocker and should be avoided.


References:

1. McGirr A, Berlim MT, Bond DJ, et al. A systematic review and meta-analysis of randomized, double-blind, placebo-controlled trials of ketamine in the rapid treatment of major depressive episodes. Psychol Med 2015; 45:693. 

2. Ghasemi M, Kazemi MH, Yoosefi A, et al. Rapid antidepressant effects of repeated doses of ketamine compared with electroconvulsive therapy in hospitalized patients with major depressive disorder. Psychiatry Res 2014; 215:355. 

3. Murrough JW, Soleimani L, DeWilde KE, et al. Ketamine for rapid reduction of suicidal ideation: a randomized controlled trial. Psychol Med 2015; 45:3571.