Ketamine may be an emergency deterrent for people at risk of suicide

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MONDAY, Feb. 7, 2022 (HealthDay News) — A new clinical trial strengthens the case that ketamine – once famous as a club drug – can quickly relieve suicidal thoughts.

The researchers found that among 156 adults hospitalized for severe suicidal thoughts, those given two doses of ketamine often saw those disturbing thoughts disappear within a few days.

By day three, 63% were fully remissioncompared to just under 32% of patients who received a placebo in addition to standard care.

The study, published February 2 in the British medical journal— is the last to look at the mental health effects of ketamine. The drug was approved in the United States decades ago as an anesthetic, later becoming popular as a party drug, known by names like “Special K,” due to its mind-altering effects.

But researchers have long known the potential for ketamine, at low doses and under well-controlled conditions, to treat psychiatric symptoms.

In recent years, it has become something of a wonder drug for patients with severe depression that does not improve with standard treatment.

For those people, ketamine can sometimes bring quick relief, even within a day. Experts say it’s especially critical for people at high risk of harming themselves.

The new findings add to evidence that ketamine can help such patients get through the crisis, said Dr. Paul Kim, an assistant professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine, in Baltimore. .

Of course, that’s not the end of the story, and people need follow-up care. Kim said that could mean changing any antidepressant therapy a patient has been taking, including dosage.

“Sometimes they are found to not have an effective therapeutic dose,” noted Kim, who was not involved in the study.

While ketamine can work quickly, it’s not easy to take. It has to be administered by infusion, under careful medical supervision, largely because of its “dissociative” effects, or what laymen call a trip.

Ketamine typically triggers altered perceptions of reality, such as hallucinations, shortly after it occurs. It can also cause a short-term spike in blood pressure.

It’s not entirely clear exactly how ketamine brings relief to people in deep distress. But researchers do know that the drug has brain targets that are different from standard antidepressants, and that includes increasing the activity of a chemical called glutamate, which helps brain cells communicate with each other. Studies also suggest that ketamine encourages the regrowth of synapses, connections between brain cells that can be depleted in people with long-term depression.

At new study, researchers in France recruited patients who were voluntarily admitted to hospital for severe suicidal thoughts. All received standard care, including antidepressants, talk therapy and family meetings.

Additionally, 73 were randomly assigned to receive two ketamine infusions, 24 hours apart. The rest of the patients were given placebo infusions for comparison.

By day three, the ketamine patients had twice the rate of remission, meaning their suicidal thoughts had resolved. The difference was no longer statistically significant after six weeks, as patients in both groups fared better: 69.5% of patients receiving ketamine were in remission, as were 56% of patients receiving placebo.

The trial produced an unexpected result: the initial benefit of ketamine was seen primarily in patients with bipolar disorder, rather than major depression.

That’s surprising because ketamine is typically given to people with severe depression and not bipolar disorder, said Dr. Riccardo De Giorgi of the University of Oxford in England, who wrote an editorial published with the study.

“It may suggest that the biological and psychological mechanisms behind suicidal ideation might differ between these two disorders, an important avenue for future research,” he said.

But given previous evidence that ketamine can benefit people with depression and suicidal thoughts, the picture is not clear. The bottom line is that continued research is needed, according to De Giorgi.

Ketamine is not approved by the US Food and Drug Administration for the treatment of depression. But doctors can and do prescribe it “off label” for that reason.

Additionally, there is an FDA-approved version of ketamine called esketamine (Spravato). It was first approved in 2019 for treatment resistant depressionand later for people with depression and acute suicidal thoughts and behaviors.

Because esketamine is FDA-approved and more likely to be covered by insurance, it may be the choice over ketamine in the real world, according to Kim.

Another difference is that esketamine is given as a nasal spray.

However, Kim said, esketamine is still administered under medical supervision, not at home, because it can have the same side effects as ketamine.

He agreed that continued investigation is necessary. Ketamine and esketamine are still new to the field of managing depression and suicidal thoughts, Kim said, and providers are trying to figure out how to better integrate them into care.

But people should know help is out there, Kim and De Giorgi said.

“Even when life seems to be at its darkest, help is available,” De Giorgi said. “If suicidal thoughts are the problem, please call for help.”

Yes ketamine is an option, he said, will depend on the circumstances of the individual, as well as the availability of the drug. There is no one size fits all, and De Giorgi said people should talk to their provider about the best treatment plan for them.

More information

The National Alliance on Mental Illness has more on dealing with mental health crises.

SOURCES: Riccardo De Giorgi, MD, Wellcome Trust Doctoral Training Fellow, University of Oxford, UK; Paul Kim, MD, PhD, assistant professor, psychiatry and behavioral sciences, Johns Hopkins University School of Medicine, Baltimore; British medical journalFebruary 2, 2022, online

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