The effects of ketamine on suicidality across various formulations and study settings

Abstract

IntroductionSuicidality and self-injurious behavior afflict patients with a wide variety of psychiatric illnesses. Currently, there are few pharmacologic treatments for suicidality and self-injurious behavior and none that treat these conditions emergently. Recently, ketamine has demonstrated efficacy in treating both depression and acute suicidal ideation. An increasing usage of ketamine, of a variety of formulations, has been studied for these indications. This article reviews the evidence for use of ketamine in self-injurious behavior and suicidality.MethodsA review of the MEDLINE database for articles relating to ketamine, self-injurious behavior, suicidality, and self-harm was conducted. Additional articles were assessed via cross-reference.ResultsA total of 24 articles that included clinical trials, meta-analyses, case series, and case reports were analyzed. The majority of studies of ketamine for suicidal ideation include the intravenous route using a dose of 0.5 mg/kg over 40 minutes. These studies suggest that intravenous ketamine may be effective at reducing suicidal ideation acutely. Data on use of ketamine in the intramuscular, intranasal, and oral forms are limited and of poorer quality. Studies on these formulations contain greater variability of positive and negative results of ketamine for reducing suicidality and self-injurious behavior. The durability of the antisuicidal effects across all formulations is limited.DiscussionKetamine may be an effective option for the treatment of suicidal ideation in patients across inpatient, outpatient, or emergent settings. At this time, more research is needed on the efficacy of ketamine across all formulations being used in clinical practice.

The Impact of Ayahuasca on Suicidality: Results From a Randomized Controlled Trial

“…For instance, ECT (Tanney, 1986; Prudic and Sackeim, 1999; Kellner et al, 2005) and traditional interventions for suicidality require ongoing administration in order to maintain their antisuicidal effects (Valuck et al, 2009). Similarly, research suggests that ketamine also requires repeated administration in order to maintain its efficacy (Zalsman et al, 2016; Dadiomov and Lee, 2019), which is problematic given the potential for cognitive impairment and abuse with repeated administration of ketamine (Schak et al, 2016; Strong and Kabbaj, 2018). Importantly, ayahuasca is associated with a low abuse and dependence potential (Hamill et al, 2019).…”

“…Importantly, this meta-analysis suggests that the impact of ketamine on suicidality may begin to decrease within a week after administration. Moreover, there is no evidence that the antisuicidal effects of ketamine are long-lasting (Zalsman et al, 2016; Dadiomov and Lee, 2019) and there are significant concerns surrounding repeated administration of ketamine, including the potential for abuse and cognitive impairment (Schak et al, 2016; Strong and Kabbaj, 2018). Thus, there is a need for identifying alternative novel interventions for suicidality with less potential for abuse and a longer-lasting impact on suicidality.…”

Esketamine: A Novel Option for Treatment-Resistant Depression

“…[22][23][24][25][26][27][28] Although racemic ketamine has been used in active suicidal ideation and bipolar depression, the use of intranasal esketamine for these conditions is still being evaluated. 17,[30][31][32][38][39][40][41]…”

Low dose oral ketamine treatment in chronic suicidality: An open-label pilot study

“…To date, the majority of studies that have assessed the efficacy of ketamine on suicidality have utilised intravenous (IV) administration 31 . Three open-label single-dose studies evaluated the effect of IV ketamine on suicidality in patients with TRD 18 , 26 , 29 .…”