Ketamine for Suicidality in Bipolar Depression

Bipolar Disorder Clinical Trial

Official title:

Ketamine vs. Midazolam in Bipolar Depression

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT01944293
• Other study ID #: #6785
• Status: Completed
• Phase: Phase 1/Phase 2
• Start date: September 2013
• Est. completion date: October 2018

Study information

• Verified date: February 2020
• Source: New York State Psychiatric Institute
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This study is designed to compare the effectiveness of two medications, Ketamine and Midazolam, for rapidly relieving suicidal thoughts in people suffering from bipolar depression.

The first drug, ketamine, is an experimental antidepressant that early studies have shown may quickly reduce suicidal thoughts, but we are not sure how well it may work. Midazolam, the comparison drug, is not thought to reduce depression or suicidal thoughts.

Description:

Patients currently taking psychiatric medications may continue them during the study. However, if a patient is taking a benzodiazepine (such as Ativan, Klonopin, or Xanax), they will be able to take up to 2mg per day of Lorazepam during the week before the infusion, but none will be permitted in the 24 hours pre-infusion. Also, Zolpidem (Ambien) will not be permitted in the 24 hours pre-infusion. If a person chooses to participate, their dose of benzodiazepine may need to be reduced so that they can do without it during the 24 hours pre-infusion.

Participants are randomly assigned to receive a single dose of Ketamine (0.5 mg/kg) or Midazolam (0.02 mg/kg), which is given slowly, in a vein, over about 40 minutes. The study is "double-blind," meaning patients and study staff will not know which medication is in the infusion.

If a patient does not respond to the first infusion, and s/he received Midazolam, then s/he will be offered the option of a second infusion, this time with Ketamine (0.5 mg/kg). After the infusion(s), participants will have weekly research interviews for 6 weeks to monitor response.

After post-infusion research measures are completed, all subjects will receive open clinical treatment. During open clinical treatment, medication will be changed for those patients who don't respond or whose response is transient.

Participation in this study requires a brief inpatient stay, at no cost, at the New York State Psychiatric Institute (NYSPI).

Eligible participants enrolled in this study will be offered medication management visits at no cost for a total of up to 6 months combining inpatient and outpatient treatment. At the end of the 6 months of treatment patients will be referred for ongoing care.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 16
• Est. completion date: October 2018
• Est. primary completion date: September 2017
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 65 Years

Eligibility

INCLUSION CRITERIA:

• Bipolar depression with current major depressive episode (MDE). Participants may be psychiatric medication-free, or if on psychiatric medication, not responding adequately given current MDE with suicidal ideation.

• Moderate to severe suicidal ideation

• 18-65 years old

• Patients will only be enrolled if they agree to voluntary admission to an inpatient research unit at the New York State Psychiatric Institute (NYSPI) for infusion phase of treatment.

• Pre-menopausal female participants of child-bearing potential must be willing to use an acceptable form of birth control during study participation such as condoms, diaphragm, oral contraceptive pills

• Able to provide informed consent

• Subjects 61-65 years old must score 25 or higher on the Mini-Mental State Examination (MMSE) at screening

EXCLUSION CRITERIA:

• Unstable medical condition or neurological illness, including baseline hypertension (BP>140/90) or significant history of cardiovascular illness

• Significant ECG abnormality

• Pregnancy and/or lactation

• Current psychotic symptoms

• Contraindication to any study treatment

• Current or past ketamine abuse or dependence ever (lifetime); any other drug or alcohol dependence within past 6 months; suicidality only due to binge substance use or withdrawal

• Inadequate understanding of English

• Prior ineffective trial of or adverse reaction to ketamine or midazolam

• Opiate use greater than total daily dose of 20mg Oxycodone or equivalent during the 3 days pre-infusion

Related Conditions & MeSH terms

• Bipolar Disorder
• Depression
• Major Depressive Episode
• Suicidal Ideation

Intervention

Drug:
• Ketamine
Single dose of 0.5 mg/kg of Ketamine given intravenously (in the vein) over 40 minutes
• Midazolam
Single dose of 0.02 mg/kg of Midazolam given intravenously (in the vein) over 40 minutes

Locations

Country	Name	City	State
United States	Columbia University/New York State Psychiatric Institute	New York	New York

Sponsors (2)

Lead Sponsor	Collaborator
New York State Psychiatric Institute	Brain & Behavior Research Foundation

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Change in Suicidal Ideation Measured With the Beck Scale for Suicidal Ideation	Change in suicidal ideation in Bipolar Disorder during a Major Depressive Episode (MDE), with moderate to severe suicidal thoughts, from the pre-infusion baseline to 24 hours after the infusion of Ketamine (study drug) or Midazolam (active control).	At 24 hours post-Infusion
Secondary	Change in Systolic Blood Pressure	Blood pressure is measured in millimeters of mercury.	During study infusion

External Links

•   Channel 7 NYC Story about Ketamine Research at Columbia University Medical Center
•   MIND Clinic for Mood and Personality Disorders