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.

cross-posted from: https://lemmy.world/post/8180477

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.

  • sky@codesink.ioEnglish
    11·
    1 year ago

    My therapist recommended this for me, or esketamine which my insurance may cover, but my doctor thought trying a regular antidepressant first was best, despite having tried many before.

    I am doing better than I was, for sure, but I do wonder if I could be even better. I’m also honestly lucky to have made it through the dark period before the meds kicked in.

    • ickplant@lemmy.worldOPEnglish
      2·
      1 year ago

      I’m glad you made it through that dark period. Is your doctor no longer willing to consider esketamine since the antidepressant is sort of working? That’s too bad, if so. I know insurance can be picky with what they cover, too. I have a lot of hope that all of this will improve as psychedelic treatment for depression becomes more and more commonplace. For now, give us a follow at Psychedelic Therapy, and see if your doctor changes their mind!