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.
Note that this is simply because this study looked at differences for up to a week. Other studies suggest there is a more sustained effect, although it’s not permanent. Antidepressants aren’t permanent either. The argument is to get insurance to cover ketamine since it is a promising treatment for suicidal ideation (and some are starting to cover it).
Was gonna say, I don’t remember ket being that expensive through the, err, unregular channels. Then again I’m not in America this would just be free here.
Not sure what you mean with infusion, I assumed IV meant intra-venous, which, yeah some folks do that unfortunately, though now that I think about it I think it would mostly be done intra-muscular (in a muscle rather than a vein).
A single dose of IV ketamine is generally quite expensive.
If the effects last a week, might not be worth it
Note that this is simply because this study looked at differences for up to a week. Other studies suggest there is a more sustained effect, although it’s not permanent. Antidepressants aren’t permanent either. The argument is to get insurance to cover ketamine since it is a promising treatment for suicidal ideation (and some are starting to cover it).
You mean it’s more reasonable to just die?
Unfortunately, those are the options most Americans have. Either pay more than you can afford to fix it or let it kill you.
Uh there are a lot of anti depressants out there. I pay $15/mo for mine. This is just misinfo and xenophobia.
What’s “expensive”?
About $300 per session. The ketamine itself is cheap, the doctor’s time is what you’re paying for.
Was gonna say, I don’t remember ket being that expensive through the, err, unregular channels. Then again I’m not in America this would just be free here.
Do people do ketamine infusions where you are?
Not sure what you mean with infusion, I assumed IV meant intra-venous, which, yeah some folks do that unfortunately, though now that I think about it I think it would mostly be done intra-muscular (in a muscle rather than a vein).