NEW YORK (AP) - Depression, rage, suicide: These are the dark ingredients of the last play written by Sarah Kane before she killed herself at age 28. Now an operatic version, as dazzling as it is disturbing, is having its U.S. premiere.

“4.48 Psychosis,” composed by Philip Venables and adapted from the play of the same title, premiered to critical and popular acclaim in London and will be performed here at the annual Prototype festival dedicated to promoting new work.

“I was immediately taken with the piece,” said Beth Morrison, one of the directors of Prototype. “Is it depressing? Of course it is. It’s sobering, difficult. … But we look to works like this to express the human condition, and the things that we suffer with as humans and as a society.”

Kane burst onto the scene in 1995 with her first play, “Blasted,” which shocked audiences because of its explicit sex and violence. “4.48 Psychosis” premiered in 2000, a year after Kane hanged herself. The play’s title seems to refer to the precise minute when the troubled playwright would spontaneously awaken and have a period of lucidity before needing her next dose of medication at 6 a.m.

The play’s structure is unique: no list of characters, no indication who speaks which lines, no clear narrative, barely any stage directions. For Venables, that provided enormous challenges but also a welcome freedom.

“It has this huge range of different text modes,” he said in an interview this week at the Baruch Performing Arts Center, where the opera opens Saturday for six performances. “So it’s not just monologue or dialogue. Some of it isn’t even verbal text. It’s doctors’ notes, or a list of numbers, not necessarily to be spoken.

“You can divide it how you like, which gives you amazing flexibility musically,” he said.

He chose to write it for six female singers, two of whom sometimes take on the roles of patient and therapist. “The text clearly has a polyphony of voices, like opposing voices in your head,” Venables said. “I wanted to render that into real musical polyphony. That’s why I chose to have six voices onstage.”

The orchestral score calls for saxophones, violas, an accordion, bass, flute and piccolo. There are also what Venables calls “bits and bobs” of percussion instruments - including a wood saw. Plus pre-recorded sounds of static and “elevator music.”

The 90-minute piece was originally presented jointly in 2016 by the Royal Opera and the Guildhall School of Music & Drama. Typical of the critical response was the review by The Guardian’s Tim Ashley, who called it “a remarkable achievement” and added that “it confirms Philip Venables‘ reputation as one of the finest of the younger generation of composers working today.”

So enthusiastic was the reception that it was revived in London last year. And future productions are already planned in Dresden, Germany, and Strasbourg, France.

“How much it has snowballed took me by surprise,” Venables said. “I mean I felt proud of the piece and I felt I had achieved what I wanted. But one never knows how audiences will respond. I would never have thought that two years later I would be in New York.”

Little has been changed since the premiere. Director Ted Huffman is again in charge of the production and much of the cast is intact. William Cole, who worked with the original conductor in London, will lead with orchestra.

But Venables said he and his collaborators did tinker with the ending, which in the original production introduced a rope for the protagonist to use in her death.

“When we revived it in 2018 we took it away because we didn’t need it,” he said. “It was too much, too obvious. Now she just looks up at the ceiling and you kind of know.”

The music, which is often jagged and blaringly dissonant, becomes more calm and elegiac in its closing pages as the main character is left alone onstage.

“I wanted it to feel cathartic at the end,” Venables said. “There is clearly a lot of suffering during the piece, and in that sense there is a sense of rest, or arrival, of an end of suffering, a kind of respite.”

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