The People's Perspective on Medicine

Could Suicide Be Prevented with Better Access to Ketamine?

Suicidal thoughts are scary. They require immediate attention. But what can health professionals do? Drugs take weeks to work. Would access to ketamine save lives? Where's the FDA?

Anthony Bourdain, Kate Spade, Robin Williams, Kurt Cobain and Marilyn Monroe are just a few of the celebrities who have taken their own lives. To say their deaths made headlines would be an understatement. That is largely because the public is shocked that people who are rich, successful and admired by millions would commit suicide. But major depression can strike anyone—rich people or poor people, stars or unknowns, teenagers or senior citizens. We cannot help but wonder whether better access to ketamine, a very old drug, might help prevent some suicides.

Unanticipated Outcomes of Intense Media Coverage:

We’re often disappointed by the publicity that surrounds high-profile suicides. The morbid curiosity and sensational coverage by the media appear to trigger more suicides. A study published in the journal PLoS One (Feb. 7, 2018) notes that the suicide rate went up 10 percent in the four months following the suicide of Robin Williams.

It has been reported that:

“After Marilyn Monroe’s death, suicides increased by 12 percent.”

What Can People Do?

The advice that frequently accompanies such tragic events is somewhat unsatisfying. People are urged to seek help if they have suicidal thoughts. That seemingly makes sense on the surface, but mental health resources are stretched to the breaking point.

There is an increasing shortage of psychiatrists in the United States. Mental health resources have been underfunded for years. According to the American Psychiatric Association:

“The number of psychiatric hospital beds in the U.S. has dropped significantly in the past several decades — more than 96 percent since the 1950s and more than 17 percent just since 2010…”

That means that people with major depression may end up waiting for days in emergency rooms until a bed becomes available. Ask any emergency physician about the challenges of dealing with suicidal patients and you will get an earful.

The Limits of Current Therapy:

Even when patients in crisis finally get professional care, the options that are available are limited. Antidepressant medications can take several weeks to start working. Someone who is suicidal may not be able to wait that long. Drugs like citalopram (Celexa), fluoxetine (Prozac) and sertraline (Zoloft) don’t work for everyone.

Access to Ketamine? A Major Controversy!

That’s why there is growing interest in an old drug that offers promise of fast-onset antidepressant action. An injectable anesthetic called ketamine (Ketalar) has been used since the 1970s.

One study published in the Journal of Psychiatric Research (online, Aug. 12, 2014) reported that:

“Ketamine was associated with reductions in suicidal ideation…Furthermore, ketamine had an impact on increased wish to live and decreased wish to die…”

A review of the medical literature published in the Journal of Clinical Psychiatry (March-April, 2018) notes that a single sub-anesthetic dose of ketamine:

“is associated with antisuicidal benefits that emerge within an hour of administration and persist for up to a week.”

This suggests that if people could get access to ketamine when they need it, it might save lives. That’s especially true if drug treatment is part of a comprehensive support program.

FDA and Access to Ketamine:

The FDA has not approved ketamine for depression or suicide prevention. That is because the drug has been available generically for years. No pharmaceutical company wants to go through the process of seeking FDA approval for a drug that is off patent and readily available.

Insurance companies are unlikely to pay for these infusions. Even though the drug is accessible at an affordable price, many clinics are now charging high prices to administer ketamine. That means people in crisis would likely have to pay out of pocket for an unapproved use. Many cannot afford it.

There is also resistance from the medical community. Many clinicians remain unconvinced that ketamine could be helpful against depression or suicide. They don’t understand how it works. Unless the FDA gives a stamp of approval there is going to be legitimate resistance to its use for suicide prevention.

Nasal Spray Esketamine:

In a new twist, a slightly different form of this old injectable medication is being developed. Esketamine will be administered as a nasal spray. Preliminary studies are encouraging. We do not know, however, whether eskatamine will work the same way as ketamine to reduce suicidal ideation.

Until the FDA decides whether to approve esketamine, severely depressed people will need better treatment. If the experience following Robin Williams’ death is an indicator, mental health facilities will be strained during the coming months.

What do you think? Share your thoughts about access to ketamine in the comment section below.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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As a 64 year old man who has suffered a lifetime of deep clinical depression and paralyzing anxiety, I took 3 infusions of Ketamine in Raleigh, NC, where I live. Unfortunately I was not able to follow the protocol of the injections because my blood pressure was diagnosed as high at the Ketamine center, and during the course of the treatments it spiked each time to very high levels, would return to normal and then spike again. The treatments were each totally different, not-scary, but intense, acid like trips.

So much came up and down during the course of each treatment. It is expensive, but I think it is worth trying, and I may try the treatments again as Bystolic has remedied my high blood pressure. I am also very intrigued with the psilocybin mushroom research that is going on at Johns Hopkins and California. The data coming from those trials sounds even better than the Ketamine stats, but it will be a long time before more trials take place, and certainly before it’s use in treating treatment resistant depression becomes legal.

If a person like myself becomes suicidal again, which happens, but with less frequency because of the Bystolic, why would it not be worth everything to try these experimental methods. And yes it did suck to wake up from my carbon monoxide suicide attempt 5 years ago, and even worse to spend 4 days at Duke Universities incredibly awful suicide ward. With the money that Duke has one would think that they would have a facility that was conducive to healing, and not one that truly felt was the set for “One Flew Over the Cuckoo’s Nest.” Priorities?


I, personally, feel that if someone elects to commit suicide, it is because their life is unbearable. Why should such a person be forced to go on surviving because it is unlawful to take your own life. it is fairly likely that, even 10 years after their first attempt, that person will have recovered well enough to actually WANT to go on living. I can think of nothing more soul-destroying than waking up alive in a hospital bed, when it might have taken you weeks to convince yourself and to work up the courage, to kill yourself.

Many survivors of attempted suicide find that their circumstances change and they are able to have satisfying lives.

The US medical system is more broken than words can express. Yet the medical established order (from big pharma, to the FDA, to grossly overpaid physicians) has prospered to the detriment of patients. This will not change given a populace uneducated in science and math, ignorant of developed countries health care standards, medical research illiterate, and both intimidated and in gushing awe of authority figures.

My daughter has both chronic Lyme disease and a severe confection which both attack her physically and mentally on a regular basis. We have considered trying to obtain marijuana, an illegal drug, to treat her depression. Friends have recommended Ketamine, which we are more likely to try to obtain, other than the current prohibitive cost. We are not sure how to proceed, and we hope our taxpayer-funded health agencies will take a positive action sooner rather than later. Thank you for shining some light on this subject.

I am beginning to think that the FDA and the drug companies are not interested in people, but instead are interested only on what is profitable.

I got rid of two skin tags by covering them with the sticky part of a band Aid and leaving it on for three weeks. I have heard that you can get rid of warts by this method, too.

I can sure understand why so many in our society want to kill themselves. The solution? Isn’t that why Trump was elected, to Make America Great Again… meaning righteous lifestyles that don’t bring us such guild and shame. Who can live with that!

We will continue to have a problem with professionals in the medical community and policies from insurance companies until they stop placing more value on money than on human health. Many of these are publicly traded insurance companies and most doctors work for publicly traded companies that have one responsibility, and that is to their shareholders, not to their patients.

The potential of injectable Ketamine for suicidal thoughts management sounds quite plausible, and is unlikely to be researched in our country because our system has been built around the premise of medical care and research depending on profitable enterprise; not public service.

Profit reigns supreme and the public good comes second. As a result, Big Pharma is motivated to learn about drugs only if a costly product can be sold, and simple, cheaper options or methods get ignored…and our system won’t pay for them in favor of Big Pharma products.

We need to support the premise of service over profit in our medical system to get research and product development more public funding…and to get more effective, affordable pharmacologic tools in our belt.

I have medication resistant depression and the only thing that helps is Ketamine infusions. I am very fortunate that I have access and ability to them and it infuriates me that insurance does not see the benefit. Not only does it help with my depression but also my chronic pain.

I wonder how many of these “suicides” are declared suicide because the police need a quick answer so they LOOK like their doing their job.

Is Lexapro helpful in countering suicidal impulses?

I don’t think Marilyn Monroe comitted suicide. There is a lot of evidence to the contrary.
Ketamine seems to be used for a variety of conditions. This is interesting.

I totally agree, I don’t think Marilyn Monroe commited suicide either.

Diane, the only evidence to the contrary is CIA and FBI were involved in President John F Kennedy’s and Robert F Kennedy assassination. Then to accuse the Kennedy’s of involvement in Monroe’s suicide just to make them look bad for their cover-up!

This coming from a person who has no medical training nor experience with depression: why in the world would the FDA not conduct some level of testing to hopefully insure the efficacy of the drug and approve it?

This country must committ itself to better care for mental illness; as your artical points out, the resources spent today are insignificant compared to what is needed. Given the incidence of the problem, our jails and prisons are full of folks who could be treated successfully with proper care and medications. Imagine the cost of that factor alone!

“Why in the world would the FDA not conduct some level of testing to hopefully insure the efficacy of the drug and approve it?” One possible reason, monetary returns to the healthcare industry. Depression can lead to a constellation of symptoms — that is, a lot of office visits, treatment plans, and the “treatment merry-go-round.” It is very easy to argue that failure to diagnose hypothyroidism (and the failure is very stubborn, absurd, and wide-spread), the official treatment guidelines that are based on opinion and not science, and that leave unknowing patients suffering with hypothyroidism, — that this failure is for the same reasons.

It is definitely worth a try. Keep pushing to get someone to try it.

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