MIRECC / CoE
12 & 13: Ketamine Infusion to Reduce Suicide Ideation & Ketamine or Esketamine to Reduce Suicide
Risk Management and Treatment » Pharmacologic and other Somatic Treatments
12 & 13: Ketamine Infusion to Reduce Suicide Ideation & Ketamine or Esketamine to Reduce Suicide or Suicide Attempts
12
We suggest offering ketamine infusion as an adjunctive treatment for short-term reduction in suicidal ideation in patients with the presence of suicidal ideation and major depression disorder.
Strength:
Weak for
Category:
ReviewedNot-changed
13
There is insufficient evidence to recommend for or against ketamine infusions or esketamine to reduce the risk of suicide or suicide attempts.
Strength:
Neither for nor against
Category:
ReviewedNew-added
Grades and Definitions
- Strong for
- or "We recommend offering this option …"
- Weak for
- or "We suggest offering this option …"
- No recommendation
- or "There is insufficient evidence …"
- Weak against
- or "We suggest not offering this option …"
- Strong against
- or "We recommend against offering this option …"
Categories and Definitions |
||
|---|---|---|
| Evidence Reviewed* | Recommendation Category* | Definition* |
| Reviewed | New-added | New recommendation following review of the evidence |
| New-replaced | Recommendation from previous CPG that has been carried over to the updated CPG that has been changed following review of the evidence | |
| Not changed | Recommendation from previous CPG that has been carried forward to the updated CPG where the evidence has been reviewed but the recommendation is not changed | |
| Amended | Recommendation from the previous CPG that has been carried forward to the updated CPG where the evidence has been reviewed and a minor amendment has been made | |
| Deleted | Recommendation from the previous CPG that has been removed based on review of the evidence | |
| Not reviewed | Not changed | Recommendation from previous CPG that has been carried forward to the updated CPG, but for which the evidence has not been reviewed |
| Amended | Recommendation from the previous CPG that has been carried forward to the updated CPG where the evidence has not been reviewed and a minor amendment has been made | |
| Deleted | Recommendation from the previous CPG that has been removed because it was deemed out of scope for the updated CPG | |
| *Adapted from the NICE guideline manual (2012): The guidelines manual. London: National Institute for Health and Care Excellence;2012. and Martinez Garcia L, McFarlane E, Barnes S, Sanabria AJ, Alonso-Coello P, Alderson P. Updated recommendations: An assessment of NICE clinical guidelines. Implement Sci. 2014;9:72. | ||
Recommendation Resources
Ketamine is a rapid-acting general anesthetic that can be used as an adjunctive treatment for short-term reduction in suicidal ideation in patients with the presence of suicidal ideation and major depressive disorder. Ketamine infusion as a single small dose has shown moderate evidence for acute symptom improvement of suicidal ideation within 24 hours of treatment. Additionally, this moderate effect continues from one week and even up to six weeks. Considering the potential risk of addiction, continued repeat administration of ketamine is not recommended. Additionally, there is no evidence to support repeated administration for persistent suicidal ideation.
Training and Clinical Resources
This section includes recommended trainings and/or clinical resources about ketamine.
- VA Ketamine Resources
- OMSHP Ketamine and Esketamine SharePoint (requires access to VA networks)
- Somatic Treatment Community of Practice SharePoint (requires access to VA networks)
- CPG for Management of Major Depressive Disorder (MDD) (2022)
Manuals
This section includes recommended implementation manuals about ketamine.
Return to Resource OptionsWebinars
This section includes recommended webinars about ketamine.
-
Evidence of Esketamine Efficacy and Safety Presented by Drs. Gerard Sanacora & Tobias Martin - The History & Science Behind Ketamine and Esketamine Treatment for Mental Health Conditions Presented by Dr. Gerard Sanacora
-
Ketamine and Esketamine Treatment: Implications for VA Suicide Preventions Presented by Drs. Deborah Yurgelun-Todd & Perry Renshaw - Ketamine for Depression and Suicide Prevention in VA Presented by Dr. Eric Hermes
- The Status of VA Ketamine & Esketamine Services and Implications for Suicide Prevention Presented by Dr. Ilse Wiechers
Podcasts
This section includes podcasts about ketamine.
Episode 45: Ketamine for suicidal ideation Office of the Chief Medical Officer of the City of Austin, Texas (wordpress.com)- Podcast 584: Ketamine for Depression and Suicidality by Emergency Medical Minute | Podchaser
Articles
This section includes recommended articles about ketamine.
- (2022). Ketamine for the acute treatment of severe suicidal ideation: double blind, randomised placebo controlled trial. BMJ (Clinical research ed.), 376. e067194. https://doi.org/10.1136/bmj-2021-067194
- (2021). Ketamine and other glutamate receptor modulators for depression in adults with unipolar major depressive disorder. The Cochrane database of systematic reviews, 9(9). CD011612. https://doi.org/10.1002/14651858.CD011612.pub3
- (2017). Ketamine rapidly relieves acute suicidal ideation in cancer patients: a randomized controlled clinical trial. Oncotarget, 8(2). 2356-2360. https://doi.org/10.18632/oncotarget.13743
- (2018). Ketamine for Rapid Reduction of Suicidal Thoughts in Major Depression: A Midazolam-Controlled Randomized Clinical Trial. The American journal of psychiatry, 175(4). 327-335. https://doi.org/10.1176/appi.ajp.2017.17060647
- (2018). The Effect of a Single Dose of Intravenous Ketamine on Suicidal Ideation: A Systematic Review and Individual Participant Data Meta-Analysis. The American journal of psychiatry, 175(2). 150-158. https://doi.org/10.1176/appi.ajp.2017.17040472
