Some patients hospitalised with severe suicidal thoughts could benefit from ketamine treatment.
There is currently limited treatment options for people struggling with suicidal ideation, with up to 700,000 people dying from suicide each year. Up to 20 times this number attempt suicide. Rapidly resolving a suicidal crisis before it is acted on could prevent hundreds of thousands of deaths each year.
Results from a new randomised, controlled clinical trial, published in The British Medical Journal, have suggested that some patients in a severe crisis, and in particular, those with bipolar disorder, could benefit from ketamine treatment.
Ketamine as a fast-acting treatment for suicidal ideation
A team of researchers investigated the anti-suicidal effects of ketamine over a six week period among 156 adult patients in France. All of the patients were voluntarily admitted to hospital with severe suicidal ideation between April 2015 and March 2019.
Before starting the patients completed a thorough clinical assessment and were divided into three diagnostic groups: bipolar disorder, depressive disorder, or other psychiatric disorders.
Patients were randomly allocated to receive two 40 minute intravenous infusions of either ketamine or placebo (saline) over 24 hours, in addition to usual treatment.
The researchers then assessed the rate of patients in full suicidal remission at day three, finding that more patients receiving ketamine reached full remission of suicidal ideas at this point than those receiving placebo. This equated to 63 per cent of patients in the ketamine group compared with 32 per cent in the placebo group.
All side effects were rated as minor and reduced significantly between the first assessment and day four.
The authors highlight that in the ketamine group, one patient died from suicide, although this was determined by the oversight committee to be unrelated to the intervention.
These results were unchanged after adjusting for other potentially influential factors.
Effects greatest in patients with bipolar disorder
The team found that the treatment’s effect was greatest in patients with bipolar disorder, whereas no meaningful benefits were seen in patients with major depression or other mental illnesses.
The team highlighted that caution must be exercised because these data are from a very small number of participants.
Ketamine also appeared to relieve psychological pain, and the researchers suggest that this analgesic effect might explain its benefits on the reduction of suicidal ideation.
Ketamine, however, was not effective at week four and six.
Limitations of the study
The trial was relatively large and well-designed, however, the researchers acknowledge some limitations, stressing that the rapid resolution of suicidal ideas after receiving ketamine does not equate to a reduced risk of suicidal acts, notably after hospital discharge.
However, the team state that the findings indicate ketamine is rapid, safe, and effective in the short term for acute care in hospitalised suicidal patients.
They also stress that ketamine is a drug with a potential for abuse and say longer follow-up of larger samples will be necessary to examine benefits on suicidal behaviours and long-term harm.
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