Could an Old Drug (Ketamine) Stop Suicide?

Modern medicine failed Robin Williams. Even when people seek emergency help for suicidal thoughts, they rarely get adequate treatment. That’s because FDA-approved medications for depression don’t work very well in a crisis.

It can take weeks or even months for the antidepressant effect of a drug like fluoxetine (Prozac) or sertraline (Zoloft) to kick in. The FDA has required such drugs to carry a scary black box warning:

“Antidepressants increased the risk compared to placebo of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults in short-term studies of major depressive disorder (MDD) and other psychiatric disorders…Patients of all ages who are started on antidepressant therapy should be monitored appropriately and observed closely for clinical worsening, suicidality, or unusual changes in behavior.”

This puts health care providers in a quandary. About all they have to offer the 400,000 people who show up in emergency rooms with severe depression or suicidal plans is a locked psychiatric ward. In theory, patients can be observed, counseled and kept from acting on their suicidal thoughts in these locked-down facilities.

As valuable as this may be, such facilities are often overwhelmed. Patients sometimes have to wait for days in the emergency room before they can be admitted. Antipsychotic medications can tranquilize such patients but may not address the underlying suicidality.

That is why some psychiatrists are so excited about employing an old drug for a new use against suicide. Ketamine (Ketalar) has been used in operating rooms as an injectable anesthetic since the 1970s. Thirty years later, psychiatric researchers discovered that low-dose injections produced a rapid antidepressant effect. Instead of waiting weeks for a conventional antidepressant to take effect, patients get a response within hours to days. Ketamine is also reported to reduce suicidal thoughts (Depression and Anxiety, April, 2014).

A new study published in the Journal of Psychiatric Research (online, Aug. 12, 2014) found that

“ketamine was associated with reductions in suicidal ideation independent of reductions in depressive and anxiety symptoms. Furthermore, ketamine had an impact on increased wish to live and decreased wish to die, two cognitive aspects of suicidal ideation which have been shown to predict later death by suicide.”

Previous studies of ketamine’s antidepressant activity have shown that it may work when other treatments have failed. This is especially critical when someone is feeling suicidal.

Such an intervention is desperately needed, although more research will be required before the FDA would consider it for this use. Since this medication is available generically, it is unlikely that any pharmaceutical company would be willing to invest the money necessary to show that ketamine is safe and effective in a psychiatric emergency. To learn more about the pros and cons of ketamine, visit our website (www.PeoplesPharmacy.com). Because the anti-suicide effect of the injectable drug is short lived, we will need longer-acting formulations to address this public health problem and save others from Robin William’s tragic fate.