An old drug called ketamine (Ketalar), FDA-approved as an anesthetic, may turn out to be a fast-acting emergency treatment to reverse acute suicidal thoughts. It might become a lifeline for severely depressed patients.
When people become severely depressed it is not unusual that thoughts of suicide become overwhelming. This is a psychiatric emergency!
The tragedy is that we do not have fast-acting drugs to reverse this process. It can take existing medications weeks or even months to produce an antidepressant effect. Because severely depressed people can rarely wait that long, hospitalization is frequently the only recourse when someone reaches such a crisis.
But a fascinating medication called ketamine (Ketalar) starts working within a few hours and a new study suggests it just might help reduce “suicidal ideation” better than anything currently available. The research was published in the Journal of Psychiatric Research (Aug. 12, 2014).
The authors point out that “the 400,000 individuals who seek emergency treatment for suicidal thoughts and behavior each year often do not receive timely relief.” They note that according to the CDC, “Over 38,000 Americans died by suicide in 2010…” They go on to report that:
“A single subanesthetic dose (0.5 mg/kg over 40 min) of ketamine has antidepressant efficacy within hours-to-days with concomitant reductions in suicidal ideation on a similar time frame.”
In their analysis of 133 patients from four studies, the investigators conclude that:
“ketamine was associated with reductions in suicidal ideation independent of reductions in depressive and anxiety symptoms. Furthermore, ketamine had an impact on increased wish to live and decreased wish to die, two cognitive aspects of suicidal ideation which have been shown to predict later death by suicide.”
The idea that ketamine might rapidly reduce suicidal thoughts independently from its ability to diminish depression and anxiety is incredibly exciting. And ketamine may work when other antidepressants have failed. That said, we have to temper our enthusiasm for this approach with the recognition that better research is called for before this therapy can be accepted by the psychiatric community. Randomized controlled trials remain the gold standard for determining the true effectiveness of any treatment and that will be true for ketamine as well.
A downside of ketamine is the route of administration. Much of the research has been done with the injectable form of the medication. Because ketamine is approved as an anesthetic, it is usually administered intravenously as an infusion during surgery. The antidepressant research is done using a lower “subanesthetic” dose that doesn’t put patients to sleep. It does leave some people feeling “dissociated” from their surroundings. This may be described as a detached or spacy feeling that gradually fades over time.
The benefits of a single infusion may last several days, but they generally fade over time. Some investigators have been studying a series of three to six infusions over a period of three weeks, but that becomes expensive and inconvenient. That is why there is interest in an oral formulation or a nasal spray that would allow people access to the drug for a longer period of time.
Ketamine has been used as a club drug in an oral formulation. It has a slang name on the street: “Special K.” Apparently some individuals seek out the “dissociative” effect and consider it desirable rather than a liability.
To read more about ketamine for treating severe depression you may wish to read an article from earlier this spring reporting on British research. Here is a link to our article.
Share your own thoughts or experience about ketamine. We can only hope that the study published in the Journal of Psychiatric Research (Aug. 12, 2014) will spur even better research going forward. If there truly is a fast-acting and effective medication to help control suicidal thoughts, it could literally be a life-saver.
You may also find our guide to Dealing with Depression helpful in putting various approaches into perspective.
