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Ketamine for Depression, 6: Effects on Suicidal Ideation and Possible Use as Crisis Intervention in Patients at Suicide Risk.

Chittaranjan Andrade

The Journal of Clinical Psychiatry 2018 DOI: 10.4088/jcp.18f12242 (opens in new tab)

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Characteristics Review Randomized Open-label Peer reviewed
Population Patients with severe and treatment-refractory depression and suicidal ideation
Intervention Ketamine
Topics Depression Esketamine Ketamine
Key findings The authors conclude that consistent evidence indicates a single dose of subanesthetic ketamine has rapid antisuicidal action, emerging within an hour and persisting at least a week, with medium to large effect sizes in midazolam- and saline-controlled trials. The improvement in suicidal ideation is only partly explained by improvement in depression severity.

Abstract

A growing body of literature suggests that ketamine, administered in subanesthetic doses, has early-onset antidepressant action in patients with severe and even treatment-refractory depression. Many case reports, open-label studies, and randomized controlled trials (RCTs) suggest that ketamine may have dramatic antisuicidal effects, as well. This article examines the benefits of ketamine in patients with suicidal ideation with particular focus on the findings of recent RCTs and meta-analyses. Important findings are that a single dose of ketamine is associated with antisuicidal benefits that emerge within an hour of administration and persist for up to a week. The benefits are seen in patients with mild as well as clinically significant suicidal ideation. The benefits are observed in midazolam- as well as saline-controlled trials. Effect sizes are medium to large. The improvement in suicidal ideation is only partly explained by improvement in depression severity. It is concluded that there is consistent evidence that a single dose of ketamine has dramatic antisuicidal action that emerges almost immediately after dosing and persists for at least a week. The short- and intermediate-term safety and efficacy of ketamine as a crisis intervention treatment for suicidal patients merit study. Areas that need research are outlined.

Comparable studies

Other narrative reviews on ketamine for depression, most cited first.

Study Year Design Participants
Synthesizing the Evidence for Ketamine and Esketamine in Treatment-Resistant Depression: An International Expert Opinion on the Available Evidence and Implementation Adults with treatment-resistant depression 2021 Review
Ketamine: a paradigm shift for depression research and treatment 2019 Review
Rapid‐acting antidepressant ketamine, its metabolites and other candidates: A historical overview and future perspective 2019 Review
Ketamine: A tale of two enantiomers 2020 Review
Molecular mechanisms underlying the antidepressant actions of arketamine: beyond the NMDA receptor 2021 Review

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