Ketamine and Suicide Risk
Suicide is a psychiatric emergency, and there are limited pharmacological options to treat acute risk. Recent findings that intravenous ketamine is associated with reductions in suicidal thoughts have fueled interest in ketamine as an antisuicidal agent.
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Ketamine and Suicide Risk Elizabeth D. Ballard and Rebecca B. Price
Abstract Suicide is a psychiatric emergency, and there are limited pharmacological options to treat acute risk. Recent findings that intravenous ketamine is associated with reductions in suicidal thoughts have fueled interest in ketamine as an antisuicidal agent. The initial data on ketamine and suicide are promising but have not reached the level and rigor of the ketamine and depression literature (which itself is not conclusive). Existing evidence suggests ketamine has a beneficial effect on suicidal thoughts, but additional randomized trials are needed to substantiate this pattern, particularly among samples selected for high suicide risk. Future directions for the field include potential mechanisms or biomarkers of response, clinical correlates, and the relationship of ketamine to suicidal behaviors such as suicide attempts and death by suicide.
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Suicide as a Psychiatric Emergency
Over 40,000 Americans killed themselves in 2014 (Centers for Disease Control and Prevention 2016). Worldwide, it is estimated that one million individuals kill themselves each year (World Health Organization 2014). Even more prevalent is suicidal behavior that does not end in death; there are an estimated 400,000 emergency E.D. Ballard, PhD (*) Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Building 10, CRC Room 7-3345, 10 Center Drive, MSC 1282, Bethesda, MD 20892, USA e-mail: [email protected] R.B. Price, PhD Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA Western Psychiatric Institute and Clinic, 3811 O’Hara St., Pittsburgh, PA 15213, USA e-mail: [email protected] © Springer International Publishing Switzerland (outside the USA) 2016 S.J. Mathew, C.A. Zarate Jr. (eds.), Ketamine for Treatment-Resistant Depression, DOI 10.1007/978-3-319-42925-0_4
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department (ED) visits for suicide-related reasons each year (US Consumer Product Safety Commission). In the United States, the suicide rate has not declined for the last five decades (National Action Alliance for Suicide Prevention 2014), underscoring the importance of better understanding and treating suicide risk. One possible reason for the relatively stable rates of death by suicide is the dearth of effective treatments specifically targeting suicide risk. As of the writing of this chapter, only one medication is FDA-approved for suicide risk: clozapine, which is specifically indicated for reducing suicide risk in individuals with schizophrenia (Griffiths et al. 2014). The evidence around the ability of selective serotonin reuptake inhibitors (SSRIs) to decrease suicidal thoughts and behaviors is mixed (Leon et al. 2014), and controversies surrounding SSRIs and increased suicide risk, particularly in children and adolescents, may have led to decreased rates of antidepressant prescriptions (Libby et al. 2007
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