Ketamine alleviates suicidal, depressive symptoms

In patients with acute major depressive episodes (MDE), administering single or repeated intravenous ketamine infusions helps reduce suicidal and depressive symptoms, according to a meta-analysis.

Researchers searched multiple online databases for randomized clinical trials (RCTs) involving patients with a major depressive episode, consisting of intervention and comparator groups, and designating suicidal and depressive symptoms as efficacy outcomes.

The meta-analysis included 26 RCTs comprising 1,166 patients with an MDE, of which 626 received ketamine and 540 received either saline or midazolam (control). The main outcomes included changes in suicidal and depressive symptoms, response and remission rates of depressive symptoms, and safety.

Pooled data showed that compared with control, a single ketamine infusion significantly decreased suicidal symptoms at 24 h (standardized mean difference [SMD], −0.69, 95 percent confidence interval [CI], −0.98 to −0.40) and at 1 month (SMD, −0.70, 95 percent CI, −1.17 to −0.24). Repeated ketamine infusions were also associated with a similar reduction in suicidal symptoms at the end of the treatment (SMD, −0.72, 95 percent CI, −1.00 to −0.43).

Compared with control, a single ketamine infusion substantially reduced depressive symptoms, with the effect observed at 4 h (SMD, −1.74, 95 percent CI, −2.43 to −1.06), 24 h (SMD, −1.15, 95 percent CI, −1.58 to −0.72), 3 days (SMD, −0.97, 95 percent CI, −1.73 to −0.20), and 1 week (SMD, −0.89, 95 percent CI, −1.65 to −0.13). Similarly, repeated ketamine infusions led to significantly reduced depressive symptoms at the end of the treatment (SMD, −0.81, 95 percent CI, −1.16 to −0.46).

Adverse events such as headache were transient and resolved during the trials. Reported serious adverse events, including cases of hospitalizations and deaths, were not related to the interventions.