The Use of Ketamine to Treat Suicidal Ideation

Background: Suicide is one of the leading causes of death in the United States. Research has shown that the glutamate N-methyl-D-aspartate (NMDA) receptor antagonist ketamine can significantly decrease depressive symptoms, which is a leading cause of suicidal ideation (SI). Preliminary research has shown that ketamine effectively reduces SI. The purpose of this systematic review is to expand on the current understanding of ketamine as a way to treat SI. Methods: An exhaustive search of available medical literature was preformed using OVID, Google Scholar and Web of Science. Keywords included suicide and ketamine. Quality of the eligible studies were evaluated using the Cochrane GRADE method. Results: Two articles met the eligibility criteria for this review. One study was a randomized controlled trial (RCT) that evaluated the efficacy between ketamine and midazolam on the treatment of SI in adults with mood and anxiety spectrum disorders. Findings of this study showed that IV ketamine was superior to a single dose of midazolam 48-hours post-infusion. The second study was a secondary analysis of an open-label study that evaluated the effects of ketamine on SI in patients with major depressive disorder (MDD). Findings of this study showed that repeated IV infusions of ketamine rapidly reduced suicidal ideation and intensity 4 hours-post infusion with lasting long-term effects in some patients. Conclusion: The current findings provide support for the use of ketamine to reduce SI. Further research is needed to evaluate treatment duration, long-term side effects, alternative administration routes, and isolated effects of ketamine on SI. Keywords: Ketamine, depression, suicide, ideation, preventio