Acute Effects of Intravenous Sub-Anesthetic Doses of Ketamine and Intranasal Inhaled Esketamine on Suicidal Ideation: A Systematic Review and Meta-Analysis

Chen, Cheng-Chuan; Zhou, Na; Hu, Na; Jiang, Feng; Wang, Xiao-Bin

doi:10.2147/ndt.s401032

Cited by 6 publications

(4 citation statements)

References 46 publications

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“…Suicide has become a major public health concern, especially in relation to depression, with approximately 30% of subjects affected by depressive disorders who attempt suicide every year [53]. The anti-suicidal properties of glutamatergic antagonists have been reported and systematic reviews with meta-analysis highlighted positive outcomes for intravenous ketamine and ESK-NS vs. placebo in patients with TRD and suicidality [16,54,55].…”

Section: Discussionmentioning

confidence: 99%

“…The effectiveness of treatments is mainly based on objective criteria and clinicians' evaluation; however, including patients' self-rated, lived experience on changes in their symptomatology might be useful to understand the perceived helpfulness of therapies and to fill the knowledge gap about treatment outcomes [14,15]. Preliminary data focusing on clinician-rated specific symptoms and psychopathological dimensions reported beneficial effects of ESK-NS on anxiety, cognition, and physical correlates, as well as on anhedonia and suicidality in TRD patients [2,[16][17][18]. However, little evidence is available on the viewpoint of patients with TRD receiving esketamine, and it has been investigated through audio interviews [19] and self-administered questionnaires assessing cognition, quality of life, and functional outcomes [18,20,21].…”

Section: Introductionmentioning

confidence: 99%

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The Patient’s Perspective on the Effects of Intranasal Esketamine in Treatment-Resistant Depression

Pepe,

Bartolucci,

Marcelli

et al. 2023

Brain Sciences

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The effectiveness of the esketamine nasal spray (ESK-NS) for treatment-resistant depression (TRD) has been confirmed by real-world studies. Available evidence derived from clinician-rated assessments might differ from patients’ perceptions about the helpfulness of treatments. We aimed to verify the effect of ESK-NS from patients’ view in 25 TRD patients (56% males, 55.1 ± 10.9 years) treated with ESK-NS (mean dose: 78.4 ± 11.43 mg) for three months and evaluated at different time-points through clinician-rated and self-administered scales, assessing changes in depression, anhedonia, sleep, cognition, suicidality, and anxiety. We observed an overall early improvement that lasted over time (endpoint total score reduction in Montgomery-Åsberg Depression Rating Scale, p < 0.001, Beck Depression Inventory, p = 0.003). Patients reported a significant self-rated decrease in anhedonia at two months (Snaith–Hamilton Pleasure Scale, p = 0.04) and in suicide ideation at endpoint (BDI subitem 9, p = 0.039) vs. earlier improvements detected by clinicians (one-month reduction in MADRS subitem 8, p = 0.005, and subitem 10, p = 0.007). These findings confirm the effectiveness of a three-month treatment with ESK-NS in TRD patients, highlighting an overall overlapping response from patients’ and clinicians’ perspectives, although with some differential effects on specific symptoms at given time-points. Including patients’ viewpoints in routine assessments could inform clinical practice, ensuring a better characterization of clinical phenotypes to deliver personalized interventions.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Patient’s Perspective on the Effects of Intranasal Esketamine in Treatment-Resistant Depression

Pepe,

Bartolucci,

Marcelli

et al. 2023

Brain Sciences

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“…Chen et al. assessed the antisuicidal effect of ketamine as ‘large’ or ‘medium-large’ (after 4-6 and 24 hours after infusion, respectively), whereas the effect of intranasal esketamine was reported as ‘small-medium’ ( 77 ). Ketamine-induced decrease in suicidal thoughts may be partially independent of the improvement in depressive symptoms ( 71 ).…”

Section: Antidepressant and Antisuicidal Efficacy Of Ketaminementioning

confidence: 99%

Depression with comorbid borderline personality disorder - could ketamine be a treatment catalyst?

Więdłocha,

Marcinowicz,

Komarnicki

et al. 2024

Front. Psychiatry

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Borderline personality disorder (BPD) is diagnosed in 10-30% of patients with major depressive disorder (MDD), and the frequency of MDD among individuals with BPD reaches over 80%. The comorbidity of MDD and BPD is associated with more severe depressive symptoms and functional impairment, higher risk of treatment resistance and increased suicidality. The effectiveness of ketamine usage in treatment resistant depression (TRD) has been demonstrated in numerous studies. In most of these studies, individuals with BPD were not excluded, thus given the high co-occurrence of these disorders, it is possible that the beneficial effects of ketamine also extend to the subpopulation with comorbid TRD and BPD. However, no protocols were developed that would account for comorbidity. Moreover, psychotherapeutic interventions, which may be crucial for achieving a lasting therapeutic effect in TRD and BPD comorbidity, were not included. In the article, we discuss the results of a small number of existing studies and case reports on the use of ketamine in depressive disorders with comorbid BPD. We elucidate how, at the molecular and brain network levels, ketamine can impact the neurobiology and symptoms of BPD. Furthermore, we explore whether ketamine-induced neuroplasticity, augmented by psychotherapy, could be of use in alleviating core BPD-related symptoms such as emotional dysregulation, self-identity disturbances and self-harming behaviors. We also discuss the potential of ketamine-assisted psychotherapy (KAP) in BPD treatment. As there is no standard approach to the application of ketamine or KAP in individuals with comorbid TRD and BPD, we consider further research in the field as imperative. The priorities should include development of dedicated protocols, distinguishing subpopulations that may benefit most from such treatment and investigating factors that may influence its effectiveness and safety.

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“…I have read the article written by Chen et al, “Acute Effects of Intravenous Sub-Anesthetic Doses of Ketamine and Intranasal Inhaled Esketamine on Suicidal Ideation: A Systematic Review and Meta-Analysis.” 1 The authors provide an important analysis of the treatment of suicidal ideation with ketamine or esketamine, concluding that both may reduce suicidal ideation (SI) within 4–6 hours. This letter is not a rebuttal to the article but, rather, a response to further clarify a few points on the real-world use of ketamine and esketamine.…”

Section: Dear Editormentioning

confidence: 99%