Is Ketamine the Answer for Suicidal Patients?

In 2016 the US suicide rate increased by 1.2 percent, with 44,965 reported suicide deaths, placing it as the 10th leading cause of death. These statistics reflect successful attempts, the impact when considering unsuccessful attempts is far greater. For example in 2013, over 490,000 attempts were reported in the US. It’s estimated this has an economic impact of $56.9 billion in combined medical and work loss costs annually. Beyond these economic impacts, the toll on families is immeasurable.  Statistically veterans are disproportionately impacted by suicide. White men have the highest suicide rate, but in comparison male veterans rates are even higher than non-veteran males (32.1 vs 20.9 per 100,000), while female veterans compared to non veterans shows an even higher occurrences than non-veterans (28.7 vs 5.2 per 100,000).

total suicide rate in the United States over the years
The total suicide rate in the United States continues to rise. Clearly this is an issue that needs to be addressed.

Addressing this epidemic is paramount, and the National Academies of Medicine (NAM) has stated that research directly addressing comparative effectiveness of treatment strategies following a suicide attempt should be a national priority.

Over 90% of suicide deaths are by individuals who have a treatable psychiatric disorder, such as depression. The problem is standard depression treatment, specifically for those suffering from suicide ideation (SI), does not significantly or rapidly provide relief from SI. Treatment options typically include a combination of:

  • Psychotherapy or cognitive behavioral therapy
  • Hospitalization
  • Antidepressant medication
  • Electroconvulsive Therapy (ECT)
  • Case Management

While these treatments are now widely available, rates of suicide are still rising, and none of these treatments show from research to have an immediate reduction in suicidal behavior. Researching is showing that Ketamine infusion treatment is a promising superior solution to treating suicidal tendencies and SI.

Standard Suicide Interventions

suicide intervention options

Therapy

The roadblock to effective therapeutic treatment, is patients must be well enough to be motivated to attend treatment for as long as 12 months. For those suffering from severe depression, that is often not possible for them simply by the nature of their symptoms. Even for those who do consistently go their therapy visits, one third still still met the criteria for major depressive disorder after 6 months of therapy, leaving them at high risk for suicide attempts.

Medication

It can take at least four weeks for antidepressants to start having an effect. Because of this many patients stop taking them because they believe they aren’t working or to avoid the adverse effects like difficulty sleeping, weight gain/ loss, and sexual dysfunction. Beyond antidepressants, other pharmacological treatments don’t help much more. They share the same issues of delayed effect and adverse reactions, and none are specifically approved by FDA to treat suicidal behavior.

Electroconvulsive Therapy (ECT)

While ECT has shown promise in depressed patients and suicidal behavior, the time to see effects once again proves to be a barrier for this treatment. It typically takes 1-2 weeks to see any signs of relief, and requires 12 weeks of treatment. Research studies have shown as much as 50% of patients didn’t complete treatment.

Intervention Barriers

We can see from the treatment options above there are three consistent factors impacting the efficacy of these standard treatment options:

  1. Duration of treatment required before relief is felt
  2. High rates of symptoms returning or not diminishing
  3. High drop out rates from delayed relief and overall duration of treatment required, or adverse effects.

The hope is that Ketamine treatment can overcome these barriers by providing quick relief, shorter treatment options, and lower rates of symptom recurrence.

Ketamine Infusion Treatment

IV of ketamine into wrist

Research has recently discovered ketamine infusion treatments to be a promising treatment option for depression and suicidal tendencies. A single treatment appears to overcome the primary issues with standard treatment, offering immediate response, little to no adverse effects, and possible longer lasting results.

While there are some adverse effects including hallucination and sedation, these are safely dealt with in a health clinic setting. They typically appear within 5 minutes of treatment and will last from 20-40 minutes.

Ketamine has been studied as a treatment for addiction dated back as early as the 1970s. Reports from this usage indicate a universally positive response. The decreased relapse rate and increased rate of remission is attributed to ketamine’s ability to help the growth of more positive cognitive schemas and improved emotional attitudes about self to support the recovery process.

Studies have shown ketamine treatment has an immediate and direct impact on neural pathways of the limbic system. By reversing the depressed subject’s blunted reactions, it helps regulate their mind’s reaction to positive stimuli. It’s positive role in treating depression and the immediate nature of its results, has made it ideal for patients experience suicidal tendencies. A case study of a patient with severe depressive episodes and multiple previous suicidal attempts reported that the patient responded to a single dose of ketamine, describing the experience as “being reborn,” and maintained complete remission of SI for the 6-month study period. Larger studies have yield the same results. The few studies that have analyzed the long-term effects of ketamine infusions for treating SI indicate potential for long-term efficacy after a single treatment.

how ketamine works on the synapses for depression
Ketamine treatment has an immediate and direct impact on neural pathways. Image courtesy of Healio

One group that should avoid ketamine treatment options is opioid addicts. Combining ketamine with opioids can increase the risk in patients for overdose when administered together. Administration also poses challenges- IV infusions require administration by an anesthesiologists and cardiovascular monitoring.

Despite the logistics and additional costs associated with IV infusion, it could be given in the emergency room prior to hospitalization and possibly result in much better outcomes.

While initial reports from ketamine treatment for suicidal patients is promise, the clinical use of ketamine requires further research with larger samples to explore both long and short term effects. Researcher will also need to help determine the safest more effective process and dosages and define the ideal patient type to receive this treatment. The evidence so far though leaves health care providers hopeful that ketamine could become the standard treatment for acute SI.

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