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Novel treatment (new drug/intervention; established drug/procedure in new situation)
CASE REPORT
Use of ketamine for acute suicidal ideation in a patient with chronic pain on prescribed cannabinoids
  1. Daniel Bigman,
  2. Sindhura Kunaparaju,
  3. Bradford Bobrin
  1. Department of Psychiatry, Cooper University Hospital, Cooper Medical School of Rowan University, Camden, New Jersey, USA
  1. Correspondence to Dr. Daniel Bigman, bigman-daniel{at}cooperhealth.edu

Summary

Ketamine is a standard anaesthetic drug that has been studied as a possible treatment for acute suicidal ideation. Aside to the potential psychotropic effects of ketamine, a Cochrane review reported that available studies suggest a modest effect of ketamine for chronic pain months to years after surgical intervention. We present a patient with acute suicidal ideation who required immediate inpatient psychiatric admission in the setting of concurrent chronic pain on cannabinoids which could not be prescribed within our inpatient hospital setting. This presented a clinical dilemma to rapidly reverse the patient’s suicidality while substituting the patient’s prescribed cannabinoid products with an alternative pain regimen. Since there is emerging support in the use of ketamine in suicidality and chronic pain, we administered ketamine while withholding cannabinoid products and found evidence to support its use in rapid reversal of suicidal ideation and temporary chronic pain relief.

  • pain
  • suicide (psychiatry)
  • drugs: psychiatry
  • pain (neurology)
  • pain (palliative Care)

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bcr-2017-222059

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    Footnotes

    • Contributors DB designed data collection tools, monitored data collection for the whole study, wrote the statistical analysis plan, cleaned and analysed the data, and drafted and revised the paper. He is the guarantor. SK, analysed the data and drafted and revised the paper. BB analysed the data and drafted and revised the paper.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.