The effect of a single dose of intravenous ketamine on suicidal ideation: a systematic review and individual participant data meta-analysis

By S. Wilkinson, Elizabeth D. Ballard, Michael Bloch, S. Mathew, J. Murrough, A. Feder, P. Šóš, Gang Wang, C. Zarate, G. Sanacora. American Journal of Psychiatry, 2017

595 citations recorded by the source corpus.

Objective Suicide is a public health crisis with limited treatment options. We conducted a systematic review and individual participant data meta-analysis examining the effects of a single dose of ketamine on suicidal ideation. Method Individual participant data were obtained from 10 of 11 identified comparison intervention studies (using either saline or midazolam as control). The analysis included only participants with suicidal ideation at baseline (n=167). A one-stage, individual participant data, meta-analytic procedure was employed using a mixed-effects, multilevel, general linear model. The primary outcome measures were the suicide items from clinician-administered (Montgomery-Asberg Depression Rating Scale (MADRS) or Hamilton Depression Rating Scale (HAM-D)) and self-reported scales (Quick Inventory of Depressive Symptomatology-Self Report (QIDS-SR) or Beck Depression Inventory (BDI)), obtained for up to one week post-ketamine administration. Results Ketamine rapidly reduced (one day) suicidal ideation on both the clinician-administered (p<0.001) and self-reported outcome measures (p<0.001). Effect sizes were moderate-to-large (Cohen’s d=0.51–0.85) at all time points post-dose. Sensitivity analysis demonstrated that, compared to controls, ketamine had significant benefits on the individual suicide items of the MADRS, HAM-D, and QIDS-SR (all p<0.001) but not on the BDI (p=0.080). Ketamine’s effect on suicidal ideation remained significant after adjusting for concurrent changes in severity of depressive symptoms. Conclusions Ketamine rapidly reduced suicidal thoughts within one day and for up to one week in depressed patients with suicidal ideation. Ketamine’s effects on suicidal ideation were partially independent of its effects on mood, though subsequent trials in transdiagnostic samples are required to confirm that ketamine exerts a specific effect on suicidal ideation. Additional research on ketamine’s long-term safety and its efficacy in reducing suicide risk is needed before clinical implementation.

Subfields: Clinical Psychology, Experimental and Cognitive Psychology, Pharmacology

View Paper: https://www.semanticscholar.org/paper/46d024503b7a6ebc56ad5057bc295b462aa96cca

How researchers see this paper

The researchers whose trusted networks rank it highest, strongest advocate first. Every researcher gets a different order.

In Clinical Psychology

  1. C. Nemeroff
  2. M. Thase
  3. G. Sanacora

In Experimental and Cognitive Psychology

  1. C. Nemeroff
  2. G. Sanacora

In Pharmacology

  1. C. Nemeroff
  2. G. Sanacora

Citations in the corpus