Ketamine for suicidality: An umbrella review

A systematic review of systematic reviews found preliminary evidence that ketamine may reduce suicidal thoughts in the short term, but long-term effects remain unknown. Most of the 27 reviewed studies reported positive effects, though only four showed mixed or negative results. Among nine reviews of esketamine, only five found significant benefit. Common side effects included a temporary rise in pulse and blood pressure, dissociation, confusion, blurred vision, nausea, and vertigo, mostly mild. Over two-thirds of the included reviews were rated low or critically low quality, highlighting the need for further research.

Study at a glance

Abstract

The urgent need for appropriate treatment for suicide, the tenth leading cause of death, has led to numerous studies. This study aims to systematically identify and appraise systematic reviews with or without meta-analyses investigating ketamine in suicidal ideation and behaviours. Scopus, ISI, Embase, PubMed, CINAHL, PsycINFO, Cochrane Library, Google Scholar and two registries were searched without any restrictions for systematic reviews investigating the efficacy of ketamine on suicidal ideation and behaviours. The primary outcome was the final inference of ketamine effectiveness. A formal narrative synthesis was conducted, and the AMSTAR-2 tool was used to evaluate the quality of the studies. Of 27 studies that addressed ketamine for suicidal ideation, only four reported mixed or negative results, and out of nine reviews, esketamine was significantly beneficial only in five. A transient rise in pulse rate and blood pressure, dissociation, confusion, blurred vision, nausea and vertigo were the most common adverse effects; however, most were mild. More than two-thirds of the included studies qualified as of low or critically low quality. Preliminary evidence for the short-term efficacy of ketamine in suicidality was noted by the majority of reviews; however, long-term effects remained unknown. Due to the low quality of many studies and the limitations of core studies, further research is required.