Ketamine improves suicidal thoughts in depression
Meta-analysis results indicated a single dose of ketamine significantly and quickly improved suicidal ideation.
“Since 2000, several small clinical trials have demonstrated that subanesthetic doses of ketamine have rapid-acting antidepressant properties as well as potential anti-suicidal properties in patients with mood disorders (both major depressive disorder and bipolar depression),” Samuel T. Wilkinson, MD, of Yale School of Medicine, New Haven, and colleagues wrote. “Given ketamine’s rapid antidepressant effects, there is considerable interest regarding its potential ability to stabilize patients with mood disorders who are at imminent risk of suicide.”
To assess efficacy of a single dose of IV ketamine for suicidal ideation, researchers conducted a systematic review and individual participant data meta-analysis of 10 comparison intervention studies among 167 individuals with suicidal ideation. Studies used either saline or midazolam as a control treatment.
At baseline, participants had a mean Montgomery-Åsberg Depression Rating Scale (MADRS) score of 33.4.
Analysis showed that within 1 day, ketamine significantly reduced suicidal ideation based on clinician-administered and self-report outcome measures.
Effect sizes were moderate to large at all time points after dosing, according to results.
Sensitivity analysis indicated that compared with control treatments, ketamine significantly improved individual suicide item scores on the MADRS, Hamilton Depression Rating Scale, and Quick Inventory of Depressive Symptomatology-Self Report, but not on the Beck Depression Inventory.
Ketamine’s effect on suicidal ideation remained significant when adjusting for concurrent changes in depression symptom severity.
“These results suggest that ketamine holds considerable promise as a potential rapid-acting treatment for patients at risk of suicide. Further research examining ketamine and similar compounds for the treatment of suicidal patients is urgently needed. In particular, questions remain regarding optimal patient selection, dosing frequency, clinical monitoring and follow-up assessment,” the researchers concluded. – by Amanda Oldt
Disclosures: Wilkinson reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.