Department of Psychopharmacology, National Institute of Mental Health and Neurosciences, Bangalore, India.
J Clin Psychiatry. 2018 Mar/Apr;79(2). doi: 10.4088/JCP.18f12242. Epub 2018 Mar 27.
A growing body of literature suggests that ketamine, administered in subanesthetic doses, has early-onset antidepressant action in patients with severe and even treatment-refractory depression. Many case reports, open-label studies, and randomized controlled trials (RCTs) suggest that ketamine may have dramatic antisuicidal effects, as well. This article examines the benefits of ketamine in patients with suicidal ideation with particular focus on the findings of recent RCTs and meta-analyses. Important findings are that a single dose of ketamine is associated with antisuicidal benefits that emerge within an hour of administration and persist for up to a week. The benefits are seen in patients with mild as well as clinically significant suicidal ideation. The benefits are observed in midazolam- as well as saline-controlled trials. Effect sizes are medium to large. The improvement in suicidal ideation is only partly explained by improvement in depression severity. It is concluded that there is consistent evidence that a single dose of ketamine has dramatic antisuicidal action that emerges almost immediately after dosing and persists for at least a week. The short- and intermediate-term safety and efficacy of ketamine as a crisis intervention treatment for suicidal patients merit study. Areas that need research are outlined.
越来越多的文献表明，亚麻醉剂量的氯胺酮对重度抑郁症甚至治疗抵抗性抑郁症患者具有早期抗抑郁作用。许多病例报告、开放标签研究和随机对照试验（RCT）表明，氯胺酮可能具有显著的抗自杀作用。本文探讨了氯胺酮在有自杀意念的患者中的益处，特别关注了最近 RCT 和荟萃分析的结果。重要发现是，单次氯胺酮剂量与抗自杀益处相关，这些益处在给药后 1 小时内出现，并持续长达一周。轻度和临床显著自杀意念的患者都能观察到益处。咪达唑仑和生理盐水对照试验均观察到益处。效应大小为中等到大。自杀意念的改善仅部分归因于抑郁严重程度的改善。结论是，有一致的证据表明，单次氯胺酮剂量具有显著的抗自杀作用，在给药后几乎立即出现，并持续至少一周。氯胺酮作为自杀患者危机干预治疗的短期和中期安全性和有效性值得研究。概述了需要研究的领域。
