Ketamine Can Rapidly Reduce Suicidal Thoughts

Ketamine is significantly more effective and much faster in reducing suicidal ideation in depressed patients than sedatives, according to a new study.

Researchers at Columbia University Medical Center (CUMC; New York, NY, USA) conducted a clinical trial in 80 adults with a current major depressive disorder and a Scale for Suicidal Ideation (SSI) score higher than 4 in order to test the acute effect of adjunctive, sub-anesthetic intravenous ketamine administration on clinical suicidal ideation. The patients, of whom 54% were taking antidepressant medication, were randomly assigned to receive either a ketamine or a midazolam infusion. The primary outcome measure was SSI score 24 hours after infusion.

The results revealed that within 24 hours, more patients in the ketamine group had a 50% reduction in suicidal thoughts (55%) than in the midazolam group (30%), as measured by SSI, with improvements persisting for up to six weeks. Those in the ketamine group also had greater improvement in overall mood, depression, and fatigue. Ketamine's effect on depression accounted for approximately one-third of its effect on suicidal thoughts, suggesting the treatment has a specific anti-suicidal effect. The study was published on December 5, 2017, in the American Journal of Psychiatry.

“There is a critical window in which depressed patients who are suicidal need rapid relief to prevent self-harm. Currently available antidepressants can be effective in reducing suicidal thoughts in patients with depression, but they can take weeks to have an effect,” said lead author Michael Grunebaum, MD. “Suicidal, depressed patients need treatments that are rapidly effective in reducing suicidal thoughts when they are at highest risk. Ketamine offers promise as a rapidly acting treatment for reducing suicidal thoughts in patients with depression.”

Ketamine is a rapidly acting dissociative anesthetic agent that can provide analgesia, sedation, and amnesia for rapid sequence intubation in critically ill patients. Short- and long-term effects include increased heart rate and elevated blood pressure, nausea, vomiting, numbness, depression, amnesia, hallucinations, and potentially fatal respiratory problems. Sub-anesthetic ketamine is often administered intraoperatively for postoperative analgesia due to the detached, dreamlike state it creates.

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