Clinical Trials

Inclusion Criteria:

• Current psychiatric hospital inpatient at Mayo Clinic at time of initiation of treatment.
• Ability to provide informed consent
• Male/Female
• Age 18-65 yrs.
• Major Depressive Disorder or Bipolar Disorder I or Bipolar Disorder II with Patient Health Questionnaire-9 (PHQ 9) score ≥15 at hospital assessment
• Treatment resistant depression (TRD) as defined by at least two previous antidepressant or mood stabilizing treatments for depression in adequate dose for 8 weeks
• Patient reported overall suicide risk score ≥3 on the Suicide Status Form (SSF II-R) or score of ≥1on Item 9 of PHQ-9 (all at admission assessment)
• Ability to pass comprehension assessment test related to effects of ketamine and trial objectives and criteria
• Voluntary admission

Exclusion Criteria:

• Diagnosis of schizophrenia, schizoaffective disorder, or active psychosis
• Index episode of depression greater than 2 years
• Ongoing prescription of ≥4 mg lorazepam equivalents total daily or a.m. dosing of any benzodiazepine at time of assessment
• Currently undergoing electroconvulsive therapy, deep brain stimulation or transcranial magnetic stimulation as acute series or for maintenance
• Any active or unstable medical condition as judged by principal investigator
• Previous use or abuse of methamphetamine, cocaine, stimulants (prescribed and illicit) within past 12 months
• Any current abuse or dependence of alcohol or drugs (except nicotine) and abuse or dependence of drugs and alcohol only in full remission (> 1 month, < 12 months). Patients will be allowed to enroll if their drug and alcohol abuse / dependence is in full (complete, not partial) sustained (> 1 year) remission.
• History of traumatic brain injury
• Developmental delay and intellectual disorder
• Encephalopathy (clinical diagnosis within prior 12 months of delirium)
• Cognitive disorder (mild and major)
• Previous participation in earlier Ketamine trial
• Pregnancy
• Prisoners
• Involuntarily hospitalized