Stop Suicidal Thoughts with Ketamine and Esketamine (Spravato)
Ketamine and Esketamine (Spravato) as Treatment for Suicidality in Depression
“No other antidepressant intervention has as dramatic an effect on depression and suicidality as ketamine.”
Patients who are severely depressed can often be suicidal. These patients may actively wish to die, contemplate methods for self-harm, and even attempt to kill themselves. The risk of attempted suicide and completed suicide is very high in depressed patients relative to the general population. Estimates suggest that 5 -10 percent of people with a diagnosis of depression will die by suicide.
Suicide Risk as an Indication for Ketamine and Esketamine (Spravato)
Suicide risk is an important indication for ketamine treatment within the context of a depressive illness. As ketamine can have an almost immediate antidepressant effect, patients with suicidal thinking experience an almost immediate reduction in these thoughts, and in their overall depression. It appears we can stop suicidal thoughts with ketamine.
What is the Evidence?
A large number of well-designed studies have found that ketamine reduces the severity of suicidal ideation in patients with depression. The benefits are observed in both major depressive disorder (unipolar depression) and bipolar depression.
One study that pooled data from 99 patients in 5 clinical trials found that a single session of intravenous ketamine significantly reduced suicidal ideation.
Another study which pooled data from 167 patients in 10 clinical trials found that a single ketamine session resulted in moderate to large reduction in suicidal ideation within one day of the ketamine session; these benefits were measurable on several different assessment instruments. Importantly, this study also found that the effect of ketamine on suicidal ideation was at least partially independent of the effect of ketamine on depression. This suggests that ketamine may have specific anti-suicidal action over and above its antidepressant action.
Ketamine and Esketamine (Spravato) as an Emergency Intervention for Suicidality
The risk of suicide can constitute a medical emergency. Ketamine and Esketamine (Spravato) has been found to be dramatically effective in reducing measures of suicidality and hopelessness even in studies conducted in emergency department settings.
How Long Does the Effect Last?
The antidepressant effect of a single ketamine session wears off in 5-12 days in the average patient. The anti-suicidal effect wears off in parallel.
Can the Effect be Extended?
The findings of clinical research support repeated administration of ketamine to reduce suicidality in depression. For example, one study found that thrice weekly ketamine across 12 days resulted in sustained reduction in suicidal ideation during the period of treatment.
What are the Special Benefits of Ketamine and Esketamine (Spravato) Treatment in Suicidal Patients?
There are three important treatment gains that can result from ketamine intervention in suicidal patients. The first and most important is that a potentially life-threatening crisis is averted. The second is that inpatient psychiatric hospitalization can be averted. The third is that the temporary recovery buys time during which other antidepressant and anti-suicidal interventions, including psychological interventions, can be planned and implemented.
Ketamine and Esketamine (Spravato) Compared with other Antidepressant Interventions
No other antidepressant intervention has as dramatic an effect on depression and suicidality as ketamine. Antidepressant drugs and psychotherapy can take weeks to act; electroconvulsive therapy (ECT; shock treatment) has a faster onset of action than drugs or psychotherapy, but even ECT can take 1-2 weeks to substantially reduce illness severity. Ketamine and Esketamine (Spravato), in contrast, acts in hours and the effect peaks in a day’s time.
The anti-suicidal effect of ketamine has even been demonstrated in patients with longstanding depression that has not responded to antidepressant drugs.
Take-Home Message
Ketamine and Esketamine (Spravato) has a dramatic anti-suicidal effect that can begin within an hour of administration, that peaks in one day, and that wears off across a week. Ketamine and Esketamine (Spravato) infusions can therefore be used to avert life-threatening crises in depressed patients. Repeated ketamine infusions prolong the duration of anti-suicidal benefit.
Learn More
If you or someone you love is suffering from suicidal thoughts, we encourage you to reach out to COPE to learn more about our innovative, effective, evidence-based treatments. Please call our office at COPE to schedule an appointment.