The National Institute of Mental Health (NIMH) has awarded grants to two Yale School of Medicine faculty to test the safety, efficacy, and feasibility of using novel interventional psychiatry approaches to quickly reduce suicidal thoughts and behaviors in youth and adults.
Jennifer Dwyer, MD, PhD, Assistant Professor in the Yale Child Study Center and Department of Radiology; and Samuel Wilkinson, MD, PhD, Assistant Professor of Psychiatry, are among eight scientists nationally awarded grants by NIMH to study rapid-acting interventions for severe suicide risk.
According to NIMH, suicide rates have been rising steadily in the U.S. for 20 years, and people who die by suicide are likely to visit healthcare providers in the year before their death.
“Despite advances in psychiatric treatments and psychosocial interventions that reduce repeat suicide attempts, there remain few evidence-based interventions that rapidly reduce suicide risk within healthcare settings,” according to an NIMH statement. “The lack of such interventions often means that people at high risk for suicide must be treated in resource-intensive health care settings, such as the emergency department or inpatient settings. Identifying and developing rapid-acting treatments can reduce or eliminate the need for hospitalization and help ‘jumpstart’ the recovery trajectory.”
NIMH recently highlighted the eight projects chosen for this anti-suicide funding initiative. The interventional psychiatry approaches under study include ketamine and esketamine, which are fast-acting medications that can reduce symptoms of depression in hours or days, as well as transcranial magnetic stimulation, which uses magnets to activate specific parts of the brain.
Dwyer’s project is “Reducing Adolescent Suicide Risk: Safety, Efficacy, and Connectome Phenotypes of Intravenous Ketamine.” She leads a team of Yale scientists who will investigate whether intravenous ketamine (four doses over two weeks) rapidly reduces suicidal ideation in teenagers with treatment-resistant depression and suicidal thinking compared to an active control, according to NIMH. Participants will be followed over four months while receiving standard medication management and eight weeks of cognitive behavior therapy. The trial incorporates a predictive neuroimaging approach, connectome-based predictive modeling, to test whether pre-treatment fMRI measures can predict post-ketamine anti-suicidal responses.
Wilkinson’s study, “A Feasibility Trial of Esketamine Plus Cogntive Behavioral Therapy for Patients With Major Depressive Disorder Who Are Hospitalized for Suicidal Ideation,” will investigate the ability of cognitive behavioral therapy (CBT) to extend the anti-suicidality effects of intranasal esketamine in people with major depressive disorder who are hospitalized for suicidal thoughts or a suicidal attempt, according to NIMH. Participants will receive a course of esketamine with half being assigned to also complete a course of computer-assisted CBT.