Effect of intravenous ketamine on suicidality in adults with treatment-resistant depression: A real world effectiveness study.
David C J Chen-Li, Rodrigo B Mansur, Joshua D Di Vincenzo, Noah Chisamore, Erica Kaczmarek, Roger S McIntyre, Joshua D Rosenblat
Psychiatry research January 1, 2025 DOI: 10.1016/j.psychres.2024.116282 via PubMed
Summary
AI-generated from the abstractIn a real-world clinic setting, a single ketamine infusion significantly reduced suicidal ideation among 96 adults with treatment-resistant depression, as measured by the Columbia Suicide Severity Rating Scale. The reduction shifted the group average from active toward passive suicidal thoughts. A mediation analysis showed that ketamine's antisuicidal effects are partially independent of its antidepressant effects, suggesting a direct benefit on suicidality beyond mood improvement. The findings support ketamine's effectiveness for suicidal ideation outside controlled clinical trials.
Study at a glance
| Characteristics | Retrospective chart analysis Peer reviewed |
|---|---|
| Sample size | 96 |
| Population | Adult treatment-resistant depression patients in a private community clinic in Toronto, Ontario |
| Intervention | Ketamine |
| Topics | Ketamine |
| Keywords | Antisuicidal effects Suicidal ideation Ketamine therapy Suicide prevention Mental health treatment |
| Citations | 6 |
| Key finding | A single ketamine infusion significantly reduced suicidal ideation in a real-world setting, with antisuicidal effects partially independent of antidepressant effects. |
Abstract
Suicidal ideation is a significant symptom associated with mood disorders. Ketamine is an emerging treatment with rapid and robust antidepressant and antisuicidal effects observed in clinical trial populations. Herein we assessed the real-world effectiveness of ketamine in ameliorating suicidality. A retroactive chart analysis of 96 adult TRD patients that received treatment in a private community clinic in Toronto, Ontario was conducted. Suicidality and depressive symptom outcomes were assessed with the Columbia Suicide Severity Rating Scale (C-SSRS) (self-report version) and the Quick Inventory for Depressive Symptomatology Self-Report 16-Item (QIDS-SR16) respectively. The effect of ketamine on suicidal ideation was modelled using generalized estimating equations adjusting for demographic predictors and depressive symptom severity. A mediation analysis was conducted to evaluate the contribution of the antidepressant effects of ketamine on its antisuicidal properties. Mean C-SSRS score significantly decreased following a single ketamine infusion and was indicative of a reduction in suicidality from active to passive suicidal ideation on a group level. Results of the mediation analysis indicated that the antisuicidal effects of ketamine are partially independent of its antidepressant effects. Our study supports the use of ketamine in treating suicidal ideation in a real-world setting with benefits comparable to clinical trials.