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Ketamine – a anti-suicide medication?

Article in Review: Price, R. & Mathew, S. (2015). Does ketamine have anti-suicidal properties? Current and future directions. CNS Drugs, 29(3), 181-188.

Summary: Exploring the current evidence for Ketamine as a potential pharmocological intervention for suicidality. 

Ketamine has traditionally been known in the medical and veterinarian world as an anaesthetic; for surgery, chronic pain and also in pre-hospital settings. In addition to anaesthesia, ketamine has dissociative and amnesic properties – becoming detached from themselves/reality, masking what is happening around them. These effects are useful, particularly the amnesic effect when paramedics are treating traumatic injuries but it is not always used in medical settings. Ketamine entered the illicit drug scene for its euphoric effects as well as being a ‘date rape’ drug.

An interesting discovery has been the rapid anti-depressant effects observed with ketamine, making it appear an excellent treatment option for those clients at imminent risk for suicide. Price and Mathew (2015) reviewed a number of studies undertaken investigating ketamine and the anti-depressant properties; both uncontrolled and randomized controlled trials. While trial sizes were relatively small, with research reporting mixed effects, it was evident that ketamine held true to the finding that it was a rapid anti-depressant reducing significantly the reported severity of suicidal ideation. The duration of the effects were from hours to ten days (Price & Mathew 2015). These times, although not enduring, are sufficient for other therapies and interventions to be commenced.

What is typically observed when a client is hospitalised for their own safety, is that there are significant delays in waiting for psychotropic medications to reach therapeutic effect – at times many weeks. This can be the case, without reducing the severity and specificity of the suicidality, whereby risk can remain high for some time as an inpatient.

Challenges in the research have been that treatment has only been in the context of unipolar or bipolar depression (Price & Mathew 2015). This is extremely limiting in relation to the context in which ketamine can be considered a beneficial treatment. Particularly given that suicidal behaviour may exist purely in the context of stress or distressing events (in the absence of a psychiatric diagnosis) and can transcend multiple diagnoses. The active processes and causal mechanisms for the reduction in suicidal ideation found in ketamine are yet to be fully understood and expanded to other presentation types.

Further research is essential—

Reference

Price, R. & Mathew, S. (2015). Does ketamine have anti-suicidal properties? Current and future directions. CNS Drugs, 29(3), 181-188.

First published 28 March 2016

By Carmen Betterridge

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