Suicidal ideation refers to persistent, frequent thoughts of suicide, ranging from fleeting considerations to extensive planning or unsuccessful attempts [1]. Common symptoms include [2]:
- Hopelessness about the future
- The belief that others would be better off if they were dead
- Recurrent thoughts about death and dying
- Focusing on reasons to end one’s life
- Making a suicide plan
- Obtaining means to complete suicide (e.g., hoarding medication)
Left untreated, suicidal ideation can progress to suicide attempts. It is linked to other mental health issues like depression, PTSD, and substance abuse [3].
Therapeutic ketamine has shown promising effects for rapidly reducing suicidal thoughts and urges in depressed patients. Multiple studies have demonstrated significant reductions in suicidal ideation scores within hours after a single low-dose ketamine infusion [4][5]. The effects remained significant for up to 7 days in some cases [6].
Ketamine is thought to target underlying neurobiology driving suicidal thoughts. It increases synaptic connections and plasticity in the prefrontal cortex, rapidly reversing neural deficits and rigid negative thinking patterns associated with suicidality [7]. It also reduces anhedonia and boosts motivation for continued living [8].
Longer-term, ketamine’s anti-suicide benefits are enhanced when combined with other treatments like cognitive behavioral therapy that teach coping skills [9]. Repeated ketamine dosing may also prevent relapse of suicidal thoughts for months at a time [10]. However, more research is still needed on how to maintain benefits.
In conclusion, ketamine has demonstrated uniquely rapid and sustained reductions in suicidal ideation compared to other antidepressants. It brings hope of buying crucial time for suicidal patients while other mood-stabilizing treatments take effect. With further study into optimal dosing schedules and psychotherapyPairing, ketamine could save many lives that would otherwise be lost to suicide.
References:
[1] Nock MK, Borges G, Bromet EJ, et al. Suicide and suicidal behavior. Epidemiol Rev. 2008;30:133–154. doi:10.1093/epirev/mxn002
[2] Rudd MD, Berman AL, Joiner TE Jr, et al. Warning signs for suicide: theory, research, and clinical applications. Suicide Life Threat Behav. 2006;36(3):255-62. doi: 10.1521/suli.2006.36.3.255.
[3] Oquendo MA, Currier D, Mann JJ. Prospective studies of suicidal behavior in major depressive and bipolar disorders: what is the evidence for predictive risk factors? Acta Psychiatr Scand. 2006;114(3):151-158. doi:10.1111/j.1600-0447.2006.00829.x
[4] DiazGranados N, Ibrahim LA, Brutsche NE, et al. Rapid resolution of suicidal ideation after a single infusion of an N-methyl-D-aspartate antagonist in patients with treatment-resistant major depressive disorder. J Clin Psychiatry. 2010;71(12):1605-1611. doi:10.4088/JCP.09m05327blu
[5] Wilkinson ST, Ballard ED, Bloch MH, et al. The Effect of a Single Dose of Intravenous Ketamine on Suicidal Ideation: A Systematic Review and Individual Participant Data Meta-Analysis of 8 Randomized Controlled Trials. Am J Psychiatry. 2018;175(2):150‐158. doi:10.1176/appi.ajp.2017.17040472
[6] Price RB, Iosifescu DV, Murrough JW, et al. Effects of ketamine on explicit and implicit suicidal cognition: a randomized controlled trial in treatment-resistant depression. Depress Anxiety. 2014;31(4):335-343. doi:10.1002/da.22253
[7] DeWilde KE, Levitch CF, Murrough JW, Mathew SJ, Iosifescu DV. The Promise of Ketamine for Treatment-Resistant Depression: Current Evidence and Future Directions. Ann N Y Acad Sci. 2015;1345:47-58. doi: 10.1111/nyas.12747.
[8] Wilkinson ST, Katz RB, Toprak M, et al. Acute and Longer-Term Outcomes Using Ketamine as a Clinical Treatment at the Yale Psychiatric Hospital. J Clin Psychiatry. 2018;79(3):17m11632. doi:10.4088/JCP.17m11632
[9] Wilkinson ST, Ballard ED, Bloch MH, et al. The Effect of a Single Dose of Intravenous Ketamine on Suicidal Ideation: A Systematic Review and Individual Participant Data Meta-Analysis of 8 Randomized Controlled Trials. Am J Psychiatry. 2018;175(2):150‐158. doi:10.1176/appi.ajp.2017.17040472
[10] Ionescu DF, Bentley KH, Eikermann M, Taylor N, Akeju O, Swee MB, Gupta A, Cusin C, Pavone KJ, Albott CS, Phelps LE, Goodwin KE, McCoy TG, Hershey T, Vons G, Mischoulon D, Ryan JP, Loo CK, Fava M, Murrough JW. Repeat-dose ketamine augmentation for treatment-resistant depression with chronic suicidal ideation: A randomized, double blind, placebo controlled trial. J Affect Disord. 2019;243:516-524. doi: 10.1016/j.jad.2018.09.055.