TY - JOUR
T1 - Ketamine for suicidal ideation in adults with psychiatric disorders
T2 - A systematic review and meta-analysis of treatment trials
AU - Witt, Katrina
AU - Potts, Jennifer
AU - Hubers, Anna
AU - Grunebaum, Michael F.
AU - Murrough, James W.
AU - Loo, Colleen
AU - Cipriani, Andrea
AU - Hawton, Keith
N1 - Funding Information:
A single infusion of ketamine may have a short-term (up to 72 hours) beneficial impact on suicidal thoughts. While confirmation of these results in further trials is needed, they suggest possible use of ketamine to treat acute suicidality. Means of sustaining any anti-suicidal effect need to be found. Suicide suicidal ideation ketamine esketamine depression national institute for health research https://doi.org/10.13039/501100000272 Oxford Health Biomedical Research Centre (BRC-1215 edited-state corrected-proof The authors wish to thank the following for providing raw data on suicidal ideation in relation to their trials: Ian Anderson, Shona Ray-Griffith, Peter Sos and Tung-Ping Su. We also wish to thank Toshi Furukawa for assistance with data extraction. Declaration of Conflicting Interests The following authors were involved in trials included in this review: M.F.G., J.W.M. and C.L. All other authors declare that there is no conflict of interest. Funding The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: A.C. is supported by the National Institute for Health Research (NIHR) Oxford Cognitive Health Clinical Research Facility in his role as NIHR Research Professor, by the NIHR Research Professorship (RP-2017-08-ST2-006) and by the NIHR Oxford Health Biomedical Research Centre (BRC-1215-20005). Personal funding from the NIHR was awarded to K.H. in his role as an Emeritus NIHR Senior Investigator. The views expressed are those of the authors and not necessarily those of the UK National Health Service, the NIHR or the UK Department of Health. ORCID iDs Katrina Witt https://orcid.org/0000-0002-1489-4573 Colleen Loo https://orcid.org/0000-0003-3267-0554 Andrea Cipriani https://orcid.org/0000-0001-5179-8321 Supplemental material Supplemental material for this article is available online.
Funding Information:
The authors wish to thank the following for providing raw data on suicidal ideation in relation to their trials: Ian Anderson, Shona Ray-Griffith, Peter Sos and Tung-Ping Su. We also wish to thank Toshi Furukawa for assistance with data extraction. The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: A.C. is supported by the National Institute for Health Research (NIHR) Oxford Cognitive Health Clinical Research Facility in his role as NIHR Research Professor, by the NIHR Research Professorship (RP-2017-08-ST2-006) and by the NIHR Oxford Health Biomedical Research Centre (BRC-1215-20005). Personal funding from the NIHR was awarded to K.H. in his role as an Emeritus NIHR Senior Investigator. The views expressed are those of the authors and not necessarily those of the UK National Health Service, the NIHR or the UK Department of Health.
Publisher Copyright:
© The Royal Australian and New Zealand College of Psychiatrists 2019.
PY - 2020/1/1
Y1 - 2020/1/1
N2 - Objective: Ketamine may reduce suicidal ideation in treatment-resistant depression. But it is not known how quickly this occurs and how long it persists. We undertook a systematic review and meta-analysis to determine the short- and long-term effectiveness of ketamine for suicidality. Method: CENTRAL, EMBASE, Medline, and PsycINFO were searched until 12 December 2018. Randomised controlled trials of ketamine or esketamine reporting data on suicidal ideation, self-harm, attempted or completed suicide in adults diagnosed with any psychiatric disorder were included. Two reviewers independently extracted data, and certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation tool. Standardised mean difference was used for continuous outcomes. Results: Twenty-five reports from 15 independent trials, with a total of 572 participants diagnosed with predominately affective disorders, were included. The evidence was rated moderate to low. In most trials, ketamine was administered at 0.5 mg/kg via a single intravenous infusion over a 30- to 45-minute period. Only a single trial of intranasal esketamine was identified. At 4 hours post-infusion, treatment with ketamine was associated with a significant reduction in suicidal ideation scores (standardised mean difference = −0.51, 95% confidence interval = [−1.00, −0.03]), which persisted until 72 hours post-infusion (time points between 12 and 24 hours: standardised mean difference = −0.63, 95% confidence interval = [−0.99, −0.26]; between 24 and 72 hours: standardised mean difference = −0.57, 95% confidence interval = [−0.99, −0.14]), but not thereafter. However, there was marked heterogeneity of results. In a single trial of esketamine, marginal effects on suicidal ideation were observed. In terms of actual suicidal behaviour, there were virtually no data on effects of ketamine or esketamine. Conclusion: A single infusion of ketamine may have a short-term (up to 72 hours) beneficial impact on suicidal thoughts. While confirmation of these results in further trials is needed, they suggest possible use of ketamine to treat acute suicidality. Means of sustaining any anti-suicidal effect need to be found.
AB - Objective: Ketamine may reduce suicidal ideation in treatment-resistant depression. But it is not known how quickly this occurs and how long it persists. We undertook a systematic review and meta-analysis to determine the short- and long-term effectiveness of ketamine for suicidality. Method: CENTRAL, EMBASE, Medline, and PsycINFO were searched until 12 December 2018. Randomised controlled trials of ketamine or esketamine reporting data on suicidal ideation, self-harm, attempted or completed suicide in adults diagnosed with any psychiatric disorder were included. Two reviewers independently extracted data, and certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation tool. Standardised mean difference was used for continuous outcomes. Results: Twenty-five reports from 15 independent trials, with a total of 572 participants diagnosed with predominately affective disorders, were included. The evidence was rated moderate to low. In most trials, ketamine was administered at 0.5 mg/kg via a single intravenous infusion over a 30- to 45-minute period. Only a single trial of intranasal esketamine was identified. At 4 hours post-infusion, treatment with ketamine was associated with a significant reduction in suicidal ideation scores (standardised mean difference = −0.51, 95% confidence interval = [−1.00, −0.03]), which persisted until 72 hours post-infusion (time points between 12 and 24 hours: standardised mean difference = −0.63, 95% confidence interval = [−0.99, −0.26]; between 24 and 72 hours: standardised mean difference = −0.57, 95% confidence interval = [−0.99, −0.14]), but not thereafter. However, there was marked heterogeneity of results. In a single trial of esketamine, marginal effects on suicidal ideation were observed. In terms of actual suicidal behaviour, there were virtually no data on effects of ketamine or esketamine. Conclusion: A single infusion of ketamine may have a short-term (up to 72 hours) beneficial impact on suicidal thoughts. While confirmation of these results in further trials is needed, they suggest possible use of ketamine to treat acute suicidality. Means of sustaining any anti-suicidal effect need to be found.
KW - Suicide
KW - depression
KW - esketamine
KW - ketamine
KW - suicidal ideation
UR - http://www.scopus.com/inward/record.url?scp=85075147455&partnerID=8YFLogxK
U2 - 10.1177/0004867419883341
DO - 10.1177/0004867419883341
M3 - Review article
C2 - 31729893
AN - SCOPUS:85075147455
SN - 0004-8674
VL - 54
SP - 29
EP - 45
JO - Australian and New Zealand Journal of Psychiatry
JF - Australian and New Zealand Journal of Psychiatry
IS - 1
ER -