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

 Depressed 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). S/he
 will then start treatment with a standard antidepressant, unless s/he is not already taking
 one.

 After the infusion(s), participants will have weekly research interviews for 6 weeks to
 monitor response.

 If a patient does have a sufficient infusion response, and s/he is not already taking an
 antidepressant, then s/he will receive 6-weeks antidepressant research treatment with
 Sertraline, Fluoxetine, Paroxetine, or Escitalopram, followed by open clinical treatment.
 However, if s/he is already taking an antidepressant, then s/he will receive open treatment.
 If s/he does not have a sufficient infusion response, then s/he will receive open treatment.

 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 from the date of enrollment combining inpatient and
 outpatient treatment. Study medications (Sertraline, Fluoxetine, Paroxetine, Escitalopram,
 Lorazepam, Zolpidem) will be at no cost during the 6 months. The study will not provide other
 medications at no cost.
INCLUSION CRITERIA:

 -  Unipolar 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 (See 2).

 -  Moderate to severe suicidal ideation

 -  18-65 years old

 -  Participants must agree to a voluntary admission to an inpatient research unit at the
 New York State Psychiatric Institute (NYSPI)for the infusion(s), for a brief stay, or
 longer if clinically necessary.

 -  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, or oral contraceptive pills.

 -  Able to provide informed consent

 -  Participants 61-65 years old must score a 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

 -  Pregnant or lactating

 -  Diagnosis of bipolar disorder or psychotic disorder

 -  Contraindication to any study treatment.

 -  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.

 -  A diagnosis of sleep apnea.