Worldwide, about 700,000 people die by suicide each year, 10 to 20 times more than attempted suicide. Suicide is the second leading cause of death among adolescents and young adults. Within 12 months, 2% of adults worldwide had suicidal thoughts, and 0.5% of them had a suicide program. Recently, a research paper was published in the top journal BMJ, in which researchers aimed to identify the anti-suicide benefits of ketamine that acted quickly in the short term and within six weeks.
The study was conducted between 13 April 2015 and 12 March 2019 in seven French teaching hospitals. Participants were 18 years of age or older, currently had suicidal ideation, and were voluntarily admitted to hospital. Exclusion criteria included a history of schizophrenia or other psychosis, substance dependence, and contraindications to ketamine.
Fifteen6 participants were recruited and randomly assigned to either placebo (n=83) or ketamine (n=73), stratified by center and diagnosis: bipolar disorder, depression, or other disorders. In addition to usual therapy, intravenous infusions of ketamine (0.5 mg/kg) or placebo (normal saline) are given twice at baseline and at 24 hours. The main result of the study was that patients achieved a complete suicidal response rate on day 3, based on a scale of ≤3 on a total score of suicidal ideation. The analysis was conducted on the basis of intentional treatment.
More participants receiving ketamine achieved complete suicidal ideation on day 3 than those who received placebo: 46 of the 83 subjects in the ketamine group (63.0%), and 25 out of 73 subjects in the placebo group (31.6%) (odds ratio 3.7 (95% confidence interval 1.9 to 7.3), P
In addition, the researchers also found a mediating role in mental pain. At week 6, response rates in the ketamine group remained high, although there was no significant difference compared with placebo (69.5% vs. 56.3%; odds ratio was 0.8 (95% confidence interval 0.3 to 2.5), P=0.7).
Thus, the results of the study suggest that ketamine treatment is fast and safe in the short term, and has sustained benefits for acute treatment of patients with suicide. Concomitant mental disorders appear to be an important regulator, and the analgesic effect of ketamine on mental pain may explain its anti-suicidal effects.
Original source:
Mocrane Abbar,etal. Ketamine for the acute treatment of severe suicidal ideation: double blind, randomised placebo controlled trial. BMJ.2022;https://www.bmj.com/content/376/bmj-2021-067194
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