Titrated Serial Ketamine Infusions Stop Outpatient Suicidality and Avert ER Visits and Hospitalizations

Methods: This is a retrospective chart review of 231 adults and adolescents presenting with TRD and complex psychiatric comorbidity in a large real-world psychiatry office practice with > 5400 visits/year. Each patient underwent a 60-90 min comprehensive consultation by the single treating psychiatrist. Appropriate patients were treated with 6 serial, titrated ketamine infusions (0.5-1.2 mg/kg within 40-50 min) over 2-3 weeks. PHQ-9 was obtained at baseline and before each infusion. The presence, frequency, and intensity of suicidality expressed in PHQ-9 Item 9 was analyzed over the treatment course and correlated to decrease in total PHQ-9. Suicides, suicide attempts, ER visits and hospitalizations were analyzed over the course of treatment and for an additional 4 weeks.