Ketamina en el tratamiento de la ideación suicida asociada a depresión resistente. A propósito de un caso

There are currently very few quick, effective and safe treatments for reducing suicidal ideation in depression and especially in resistant depression, perhaps with the exception of electroconvulsive therapy (ECT). Ketamine is an anaesthetic with NMDA receptor antagonist properties that, in sub-anaesthetic doses, has demonstrated a really quick and significant improvement in depressive symptoms and suicidal ideation. The improvement in suicidal ideation produced by ketamine is independent of the improvement observed in depressive symptoms. On the other hand, in most of the cases, the improvement in the suicidal ideation is not maintained in time with a single infusion of ketamine and repeated doses are necessary to maintain the therapeutic effect. A case is presented of suicidal ideation in resistant depression with difficulties of using ECT and with a previous history of 18 psychiatric admissions. The patient improved with continuous perfusions of ketamine and minimal adverse effects.