Treatment of Suicidal Ideation With Intravenous Ketamine Infusion

This study is dedicated to achieving better treatments for suicidal thoughts. Specifically,
we are studying the effect of a medication called ketamine to quickly treat suicidal
thoughts and depression. Patients will be asked to participate in a research study to study
how the use of a medication, ketamine, decreases your suicidal thoughts and improves their
symptoms of depression. Ketamine is approved by FDA for use at higher doses in anesthesia,
and recent clinical research suggests that it might benefit patients with major depressive
disorder and suicidal thoughts. During clinical trials with over 10,000 patients, ketamine
was proved to be safe as an anesthetic and studies with hundreds of patients with depression
have demonstrated safety and lack of lasting side effects. This is a pilot study to test a
new use of ketamine: treatment of suicidal thoughts. The study medication will be given in
addition to usual psychiatric care.

Inclusion Criteria:

1. Age : 19-64

2. Significant suicidality score on the Columbia Suicide Severity Rating Scale (C-SSRS)

3. Willing and able to provide informed consent.

4. Individuals with current substance abuse are allowed

Exclusion Criteria:

1. Pregnant or lactating; women of reproductive potential must have a negative urine
pregnancy test (urine dipstick method)

2. Post-Partum state : defined as being within 2 months of delivery or miscarriage

3. Homicide risk as determined by clinical interview

4. Treatment with any medication known to specifically target the glutamate-NMDA
receptor system (ie lamotrigine, acamprosate, memantine, riluzole or lithium)

5. Any known hypersensitivity or serious adverse effect associated with ketamine
treatment.

6. Any clinically significant medical condition or therapy that would preclude treatment
with ketamine, to include recent myocardial infarction or unstable angina

7. Medically unstable, including acute withdrawal from alcohol or benzodiazepines
requiring the use of benzodiazepine treatment.

8. Any of the following DSM-IV diagnoses or categories:

- Any current psychosis or history of a non-mood psychotic disorder (e.g.,
schizophrenia)

- Currently in a manic or mixed episode

- Current use (defined by urine dipstick test) or abuse of hallucinogenic drugs
(except marijuana) such as phencyclidine

- Any dissociative disorder

- Any pervasive developmental disorder (e.g., autism)

- A cognitive disorder (e.g., Alzheimer's Disease)

- Cluster A personality disorder (e.g., schizoid or schizotypal); note that
cluster B and C personality disorders may be included

- Any eating disorder