The Effect of a Single Dose of Intravenous Ketamine on Suicidal Ideation: A Systematic Review and Individual Participant Data Meta-Analysis
ajp.psychiatryonline.org
Objective: Suicide is a public health crisis with limited treatment options. The authors conducted a systematic review and individual participant data meta-analysis examining the effects of a single dose of ketamine on suicidal ideation. Method: Individual participant data were obtained from 10 of 11 identified comparison intervention studies that used either saline or midazolam as a control treatment. The analysis included only participants who had suicidal ideation at baseline (N=167). A one-stage, individual participant data, meta-analytic procedure was employed using a mixed-effects, multilevel, general linear model. The primary outcome measures were the suicide items from clinician-administered (the Montgomery-Åsberg Depression Rating Scale [MADRS] or the Hamilton Depression Rating Scale [HAM-D]) and self-report scales (the Quick Inventory of Depressive Symptomatology–Self Report [QIDS-SR] or the Beck Depression Inventory [BDI]), obtained for up to 1 week after ketamine administration. Results: Ketamine rapidly (within 1 day) reduced suicidal ideation significantly on both the clinician-administered and self-report outcome measures. Effect sizes were moderate to large (Cohen’s d=0.48–0.85) at all time points after dosing. A sensitivity analysis demonstrated that compared with control treatments, ketamine had significant benefits on the individual suicide items of the MADRS, the HAM-D, and the QIDS-SR but not the BDI. Ketamine’s effect on suicidal ideation remained significant after adjusting for concurrent changes in severity of depressive symptoms. Conclusions: Ketamine rapidly reduced suicidal thoughts, within 1 day and for up to 1 week in depressed patients with suicidal ideation. Ketamine’s effects on suicidal ideation were partially independent of its effects on mood, although subsequent trials in transdiagnostic samples are required to confirm that ketamine exerts a specific effect on suicidal ideation. Additional research on ketamine’s long-term safety and its efficacy in reducing suicide risk is needed before clinical implementation.

Why this is significant: There is no currently known treatment to stop suicidal thoughts when they happen. Antidepressants take 4-6 weeks to start working, and they don’t work for everyone. Therapy also takes time. Our best option for acutely suicidal people is to lock them up in a psychiatric facility until they are no longer a threat to themselves.

Intravenous ketamine offers a glimpse of hope. A single dose appears able to alleviate suicidal ideation immediately after administration and for up to a week afterwards.

  • Drusas@kbin.social
    21·
    1 year ago

    Going off of antidepressants also causes suicidal ideation, so they’re not exactly great.

    • ickplant@lemmy.worldOPM
      31·
      1 year ago

      Yes, and even getting on them can induce suicidal ideation, especially in some children and teenagers. It’s rare, but that doesn’t fucking matter if it happens to your child.

    • flooppoolf@lemmy.world
      2·
      1 year ago

      What’s great about NMDA receptor antagonism is that it is shown to have a more lasting impact on patients vs traditional treatment. So not only does it help stop suicidal ideation, as seen here, a single dose can stop it for up to a week.

      Spravato offers patients a much higher chance of achieving remission than any other treatment resistant depression regimen available, knowing that it actually stops the suicidal ideation as soon as you administer it is key in developing medication that completely eradicates suicidal ideation.

      In the meantime you can enjoy Auvelity, a drug that combines the antidepressant Bupropion with the famous OTC cough suppressant dextromethorphan in order to benefit from its hidden NMDA antagonist activity that is only found at long lasting concentrations through bupropions induction of CYP2D6.

      In the future we hopefully won’t be using drugs initially invented for cough suppression, and find a much more targeted approach thanks to the new NMDA pathway for treatment resistant depression.

      • flooppoolf@lemmy.world
        1·
        1 year ago

        Also this was found to be true already with Intranasal Spray. The article explores a much more strong handed approach via IV administration rather than through a nasal spray.