brand logo

Am Fam Physician. 2022;106(3):online

Clinical Question

In patients at risk of suicide who are admitted to a hospital, does ketamine (Ketalar) reduce suicidal ideation?

Bottom Line

Ketamine can rapidly reduce suicidal ideation and, presumably, the risk of suicide in at-risk patients voluntarily admitted to a hospital. However, based on this small study, ketamine does not seem to reduce the subsequent risk of attempted suicide over the next six weeks. (Level of Evidence = 1b−)

Synopsis

The researchers from seven hospitals in France enrolled 156 adults who were voluntarily admitted to a hospital for suicidal ideation with a score of more than 3 on the Beck scale for suicidal ideation. The patients, who did not have a history of substance use or psychotic disorders, were randomly assigned using concealed allocation to receive two 40-minute ketamine infusions, 0.5 mg per kg, or saline placebo infusions, given 24 hours apart. Using intention-to-treat analysis, remission of suicidal ideation at three days (one day after the treatment) occurred more frequently in patients who received ketamine: 63% vs. 31.6%; number needed to treat = 3.2; 95% CI, 2.2 to 6.6. The onset of remission was fast, within 40 minutes of the first dose. The benefit was greater in those with bipolar disorder (84.6% vs. 28.0%; P < .001) than in those with major depression (42.3% vs. 35.7%; P = .6). Over the six weeks following admission, a similar number of patients attempted suicide in both groups (eight in the ketamine group and six in the placebo group).

Already a member/subscriber?  Log In

Subscribe

From $165
  • Immediate, unlimited access to all AFP content
  • More than 130 CME credits/year
  • AAFP app access
  • Print delivery available
Subscribe

Issue Access

$59.95
  • Immediate, unlimited access to this issue's content
  • CME credits
  • AAFP app access
  • Print delivery available
Purchase Access:  Learn More

POEMs (patient-oriented evidence that matters) are provided by Essential Evidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see https://www.essentialevidenceplus.com/Home/Loe?show=Sort.

To subscribe to a free podcast of these and other POEMs that appear in AFP, search in iTunes for “POEM of the Week” or go to http://goo.gl/3niWXb.

This series is coordinated by Natasha J. Pyzocha, DO, contributing editor.

A collection of POEMs published in AFP is available at https://www.aafp.org/afp/poems.

Continue Reading

More in AFP

More in Pubmed

Copyright © 2022 by the American Academy of Family Physicians.

This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.  See permissions for copyright questions and/or permission requests.