Ketamine for Suicidal Patients
Key Points:
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Ketamine appears to be an effective and rapid treatment for suicidal ideation.
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A single infusion of ketamine can reduce suicidal ideation for up to 6 weeks.
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Ketamine works well alongside other medications for the treatment of suicidal ideation.
What is Suicidal Ideation?
Suicidal ideation refers to either thinking about or planning a suicide. These thoughts can be on a spectrum of severity from a wish to die with no plan or intent to active suicidal ideation with a specific plan and intent. Suicidal ideation does not have to include self-harm behaviors.
Self-harm is the behavior that is self-directed and deliberately results in the harm or potential injury of the individual. It includes both suicidal and non-suicidal self-injury as well as self-harm with unclear intent. Non-suicidal self injury is a significant risk factor for both suicide attempts and death by suicide and may or may not be accompanied by suicidal ideation.
Suicide is the 2 nd leading cause of death for adolescents and young adults aged 15-24 years old and the 10th leading cause of death overall in the United States.
Does Ketamine Decrease Suicidal Ideation?
The literature shows that ketamine produces safe rapid remission of suicidal ideation, increased feelings of safety, and decreased the likelihood of self-harm with just one infusion. These results are not just related to decreasing the severity of depression but also due to cognitive improvements (problem solving and clearer thinking). These effects occur in individuals who have not responded to other antidepressants.
How Long Do These Effects Last?
Antidepressant and decreased suicidal effects vary from individual to individual. Additionally, receiving a loading dose of ketamine (6 infusions over a period of a few weeks) will be far more effective than receiving just one infusion.
Studies that used just one infusion of ketamine found that the decreased suicidal ideation lasted as long as 6 weeks allowing for other vital treatments and resources to aid the individual struggling with suicidal thoughts.
How Does Ketamine Treat Suicidal Ideation?
The exact mechanism of action of ketamine is not fully understood. However, broadly speaking, there are two major ways in which ketamine exerts its effects.
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First, within the first couple hours of a ketamine infusion, a patient can feel its anti-depressant effects. This is due to ketamine’s effects on the release of glutamate in the prefrontal cortex, hippocampus, and amygdala. This leads to rapid anti-depressive affects that occur within hours of treatment.
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Second, ketamine aids in the restoration of lost dendritic density (increasing dendritic spine number) through increasing brain-derived neurotrophic factor (BDNF). Significant increases in dendritic density begin to occur approximately 2-7 days after an infusion. It is believed that increases in dendrite density leads to the longer term anti-depressive effects of ketamine.
Because of ketamine’s effect on dendrite density (increasing the neuron’s ability to receive neurotransmitters), it works synergistically with other antidepressants (which work to increase the amount of neurotransmitters in specific regions of the brain).
How Can I Find Out More Information?
For more information, contact us or submit a request for a 15 minute consultation on our contact form.
SUICIDE HOTLINE:
If you or someone you know is contemplating suicide, please contact the National Suicide Prevention Lifeline (1-800-273-8255) or 988.
The National Suicide Prevention Lifeline is a 24-hour confidential suicide prevention service available to anyone in suicidal crisis or emotional distress. Their staff are specially trained in active listening skills and strategies for supporting people undergoing extreme emotional stress.