ketamine and suicidal ideation

Q: 32 years old male with severe depression is admitted to ICU with active suicidal ideation. A family member suggested Ketamine, as he read an advertisement on the Ketamine infusion clinic as a "feel good" substance. You should tell the family member that this is a bad idea. Ketamine increases the risk of suicidal ideation and should never be used in these patients.

A) True 

B) False

Answer: B

Interestingly, studies have suggested that a single infusion of ketamine may mitigate suicidal ideation within an hour. Moreover, this effect may last up to seven days.

Similarly, related compound esketamine can be given intranasally, which may be a preferred route when a patient is resistant to provide an intravenous line, though the evidence is not as robust as for ketamine infusion.

Said that, another objective of this question is to identify the evil of this 'feel good' effect. Lately, there has been a mushrooming of ketamine infusion clinics in many urban areas of the USA. These centers may not have proper oversight to deal with side effects or any untoward incidents with such infusions in outpatient settings.

#pharmacology

#psychiatry

References:

1. Abbar M, Demattei C, El-Hage W, Llorca PM, Samalin L, Demaricourt P, Gaillard R, Courtet P, Vaiva G, Gorwood P, Fabbro P, Jollant F. Ketamine for the acute treatment of severe suicidal ideation: double blind, randomised placebo controlled trial. BMJ. 2022 Feb 2;376:e067194. doi: 10.1136/bmj-2021-067194. PMID: 35110300; PMCID: PMC8808464.

2. Kishimoto T, Chawla JM, Hagi K, et al. Single-dose infusion ketamine and non-ketamine N-methyl-d-aspartate receptor antagonists for unipolar and bipolar depression: a meta-analysis of efficacy, safety and time trajectories. Psychol Med 2016; 46:1459.

3. Hochschild A, Grunebaum MF, Mann JJ. The rapid anti-suicidal ideation effect of ketamine: A systematic review. Prev Med. 2021 Nov;152(Pt 1):106524. doi: 10.1016/j.ypmed.2021.106524. Epub 2021 Sep 16. PMID: 34538369.