Research suggests that some patients hospitalized with severe suicidal thoughts may benefit from ketamine.
About 700,000 people die by suicide worldwide each year, and up to 20 times that number attempt suicide. Most suicidal thoughts do not lead to a suicidal act; All suicidal acts are preceded by suicidal thoughts. Therefore, resolving a suicide crisis quickly before responding could prevent many deaths.
Ketamine is a fast-acting, efficient treatment for patients hospitalized for severe suicidal ideation (thoughts), finds a clinical study published by The BMJ today.
The results suggest that some patients with severe suicidal thoughts, particularly those with bipolar disorder, may benefit from ketamine given the limited current treatment options.
Treat suicidal thoughts with ketamine
ketamine is a powerful and fast-acting sedative that quickly relieves pain without loss of consciousness. It’s approved as an aesthetic, but it’s also a promising drug to quickly reduce suicidal thoughts. However, poor quality studies have left too much uncertainty about the balance of benefits and harms in this situation to provide clinically useful evidence.
To address this, the researchers studied the antisuicidal effects of ketamine over a six-week period in 156 patients (aged 18 and older) who were voluntarily admitted to a hospital in France between April 2015 and March 2019 with severe suicidal thoughts.
Before starting the study, patients underwent a thorough clinical examination and were divided into three diagnostic groups: bipolar disorder, depressive disorder or other psychiatric disorders.
Patients were randomized to receive two 40-minute intravenous infusions of either ketamine or placebo (saline) over 24 hours in addition to usual care. The researchers then assessed the rate of patients in complete suicidal remission on day three, as confirmed by a score of three or less on a clinical suicidal ideation rate scale, based on 19 items ranging from zero to two (maximum score 38).
The results of the study
The researchers found that more patients who received ketamine achieved complete remission of their suicidal thoughts by day 3 than those who received placebo (63% of patients in the ketamine group versus 32% in the placebo group). All side effects were classified as minor and decreased significantly between the first assessment and the fourth day.
In the ketamine group, one patient died of suicide, although the oversight committee determined that it was unrelated to the intervention. These results were unchanged after adjusting for other potentially influential factors.
The effects of ketamine were greatest in patients with bipolar disorder, while no notable benefits were seen in those with major depression or other mental illnesses. However, caution should be exercised as the data comes from a small number of participants.
The drug also appeared to reduce mental pain, and the researchers suggested that this analgesic effect might explain its benefits in reducing suicidal thoughts. However, the study revealed that ketamine was not effective at weeks four and six.
These results suggest that ketamine is fast, safe, and effective in the short term for the acute care of hospitalized patients committing suicide, they wrote. However, they emphasize that ketamine is a drug with abuse potential and say longer follow-up of larger samples will be needed to examine the benefit on suicidal behavior and long-term harm.
This new study challenges current thinking about ketamine, said psychiatric specialist Riccardo De Giorgi in a linked editorial.
While it provides evidence that ketamine reduces suicidal ideation in some people, he questioned whether ketamine will be given to appropriate suicidal patients in the near future, “given the plausible concern that the widespread use of ketamine is fueling a new crisis in the opioid.” style might trigger”.
Whether emergency use of ketamine for suicidal crises is recommended in practice depends on many other factors, he added, including the values and preferences of patients, clinicians, researchers and policymakers.
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