Ketamina, alternativa de manejo

para disminuir el riesgo suicida?

Alejandro Guerra Palacio

Médico Intensivista SOMA -INDEC

• 7 Pacientes

• Depresión mayor

• Salina 0.9% como placebo

• Ketamina 0.5 mg/k infusión 40 minutos

• HDRS : Basal,80 min,230 min,24 hs,48 hs,72 hs post infusión

• VAS intox: 10 min,40 min, 80min y 110 min post infusión

• BPRS: 10 min,40 min,80 min y110 min post infusión

© 2000 Society of Biological Psychiatry

Rapid Resolution of Suicidal Ideation after a Single Infusion of an NMDA Antagonist in Patients with Treatment-Resistant MajorDepressive Disorder

• PhD, Ioline D Henter, MA, David A Luckenbaugh, MA, Rodrigo Machado-Vieira, MD, PhD,

• Experimental Therapeutics, Mood and Anxiety Disorders Program, Nation

J Clin Psychiatry. 2010 Dec; 71(12): 1605–1611.

published online 2010 Jul13. doi: 10.4088/JCP.09m05327blu

• 33 pacientes con dx de depresión resistente al tratamiento

• Sin manejo medico en las 2 semanas previas al estudio

• Reciben 0.5 mg/k de Ketamina infusion durante 40 minutos

• Se evaluaron 60 minutos antes del tto y a los 40,80,120, 180 y 240 minutos post tto.

J Clin Psychiatry. 2010 Dec; 71(12): 1605–1611.

published online 2010 Jul 13. doi: 10.4088/JCP.09m05327blu

Rapid Resolution of Suicidal Ideation after a Single Infusion of an NMDA Antagonist in Patients with Treatment-Resistant MajorDepressive DisorderPhD, Ioline D Henter, MA, David A Luckenbaugh, MA, Rodrigo Machado-Vieira, MD, PhD,Experimental Therapeutics, Mood and Anxiety Disorders Program, Nation

Rapid Resolution of Suicidal Ideation after a Single Infusion of an NMDA Antagonist in Patients with Treatment-Resistant MajorDepressive Disorder

• PhD, Ioline D Henter, MA, David A Luckenbaugh, MA, Rodrigo Machado-Vieira, MD, PhD,

• Experimental Therapeutics, Mood and Anxiety Disorders Program, Nation

Rapid Resolution of Suicidal Ideation after a Single Infusion of an NMDA Antagonist in Patients with Treatment-Resistant MajorDepressive Disorder

• PhD, Ioline D Henter, MA, David A Luckenbaugh, MA, Rodrigo Machado-Vieira, MD, PhD,

• Experimental Therapeutics, Mood and Anxiety Disorders Program, Nation

The Effect of Intravenous Ketamine in Suicidal Ideation of Emergency Department PatientsParvin Kashani1, Shiva Yousefian1, Afshin Amini1, Kamran Heidari1, Somaie Younesian1, Hamid Reza Hatamabadi1, 2* 1. Department of Emergency, Shahid Beheshti University of Medical Sciences, Tehran, Iran 2. Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

• 45 pacientes con intento suicida.

• Se excluyen a quienes hayan diagnosticado alcoholismo o drogadicción en los últimos tres meses.

• Haber sido medicados en las ultimas dos semanas.

• Ketamina 0.2 mg/k infusion 40 minutos

• Escala MADRS para depresion

• SSI para ideacion suicida

• Pre infusion K, 40, 80 y 120 minutos post K

The Effect of Intravenous Ketamine in Suicidal Ideation of Emergency Department PatientsParvin Kashani1, Shiva Yousefian1, Afshin Amini1, Kamran Heidari1, Somaie Younesian1, Hamid Reza Hatamabadi1, 2* 1. Department of Emergency, Shahid Beheshti University of Medical Sciences, Tehran, Iran 2. Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

The Effect of Intravenous Ketamine in Suicidal Ideation of Emergency Department PatientsParvin Kashani1, Shiva Yousefian1, Afshin Amini1, Kamran Heidari1, Somaie Younesian1, Hamid Reza Hatamabadi1, 2* 1. Department of Emergency, Shahid Beheshti University of Medical Sciences, Tehran, Iran 2. Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

IMPROVEMENT IN SUICIDE IDEATION AFTER KETAMINE INFUSION TO REDUCTIONS IN DEPRESSION AND ANXIETY

IMPROVEMENT IN SUICIDE IDEATION AFTER KETAMINE INFUSION TO REDUCTIONS IN DEPRESSION AND ANXIETY

• 133 PACIENTES

• DEPRESION RESISTETNE AL TRATAMIENTO

• 2 SEMANS SIN MEDICACION

• SE VALORA DEPRESION SSI

• SE VALORA IDEACION HDRS

• KETAMINA 0.5 MG/K 40 MIN

• 40,80,120,230 MINUTOS

IMPROVEMENT IN SUICIDE IDEATION AFTER KETAMINE INFUSION TO REDUCTIONS IN DEPRESSION AND ANXIETY

IMPROVEMENT IN SUICIDE IDEATION AFTER KETAMINE INFUSION TO REDUCTIONS IN DEPRESSION AND ANXIETY

• 27 pacientes

• DEPERSION RESISTENTE AL TRATAMIENTO

• SE EVALUA IDEACION SUICIDA

• SE EVALUA DEPRESION

• KETAMINA 0.5 Mg/K 40 min

• 57 pacientes

• DEPRESION RESISTENTE AL TRATAMIENTO

• RANDOMIZADO

• KETAMINA 0.5 MG/K

• MIDAZOLAM 0.04 MG/K

• IAT ;MADRS-SI;BSSI

• MADRS

RANDOMIZADO24 PACIENTESIDEACION SUICIDA:

BSIMADRS-SI

KETAMINA: 0.5 mg/k 40 minMIDAZOLAM: 0.045 mg/k 40 min

CONCLUSIONES

• La depresión e ideación suicida son problemas importante de salud publica a nivel mundial y local

• Estrés y depresión comprometen la función neuronal y neuroplasticidad del sistema límbico principalmente a nivel de CPF

• Los antagonistas NMDA no competitivos, principalmente la Ketaminarevierten este compromiso.

• La intervención farmacológica sobre el sistema glutamatergico ofrecen nuevas alternativas de manejo a la depresión e ideación suicida

CONCLUSIONES

• El control rápido de la ideación suicida es idealapra el maneo de esta emergencia siquiatrica.

• En este momento la Ketamina es la mejor alternativa apra lograrlo

• La adicon de litio en el manjoe de la ideacion suicida potenciliza y prolonga el efecto de la ketamina.

• La mamanyina, lescolpolamina los antagonsitas del receptor GluN2B pueden llegar a ser nuevas alternativas terapeuticas para el manjoe de la ideacion suicida.