Suicidal ideation following ketamine prescription in patients with recurrent major depressive disorder: a nation-wide cohort study.
Yiheng Pan, Maria P Gorenflo, Pamela B Davis, David C Kaelber, Susan De Luca, Rong Xu
Translational psychiatry August 9, 2024 DOI: 10.1038/s41398-024-03033-4 via PubMed
Summary
AI-generated from the abstractKetamine prescriptions are linked to a lower risk of suicidal thoughts in people with recurrent major depressive disorder compared to other common antidepressants. Analyzing electronic health records from over 500,000 patients, the risk of suicidal ideation was 37% lower within the first week, 33% lower within the first month, and 22% lower over nine months. The protective effect was strongest in adults over 24, females, males, and White patients. This real-world evidence suggests ketamine's long-term benefits for reducing suicidal ideation, though optimal dosing and mechanisms need further study.
Study at a glance
| Characteristics | Retrospective cohort study Peer reviewed |
|---|---|
| Sample size | 514,988 |
| Population | Patients with recurrent major depressive disorder (MDD) in the US with electronic health records |
| Interventions | Ketamine other common antidepressants |
| Duration | Up to 270 days |
| Keywords | Mental-health Ketamine-therapy Suicide-prevention Depression-treatment Clinical-research |
| Citations | 14 |
| Key finding | Prescription of ketamine was associated with a significantly decreased risk of suicidal ideation compared to other common antidepressants across all time intervals from 1 day to 270 days. |
Abstract
Ketamine has gained attention for its effective treatment for patients with major depressive disorder (MDD) and suicidal ideation; Despite numerous studies presenting the rapid efficacy, long-term benefit in real-world populations remains poorly characterized. This is a retrospective cohort study using TriNetX US Collaborative Network, a platform aggregating electronic health records (EHRs) data from 108 million patients from 62 health care organizations in the US, and the study population includes 514,988 patients with a diagnosis of recurrent MDD who were prescribed relevant treatment in their EHRs. The prescription of ketamine was associated with significantly decreased risk of suicidal ideation compared to the prescription of other common antidepressants: HR = 0.63 (95% CI: 0.53-0.76) at 1 day - 7 days, 0.67 (95% CI: 0.59-0.77) at 1 day - 30 days, 0.69 (95% CI: 0.62-0.77) at 1 day - 90 days, 0.74 (95% CI: 0.67-0.81) at 1 day - 180 days, and 0.78 (95% CI: 0.69-0.83) at 1 day - 270 days. This trend was especially robust among adults over 24 years of age, females, males, and White patients with recurrent MDD. This study provides real-world evidence that ketamine has long-term benefits in mitigating suicidal ideation in patients with recurrent MDD. Future work should focus on optimizing dosage regimens for ketamine, understanding the mechanism, and the difference in various demographic subpopulations.