Centre for Suicide Research, Department of Psychiatry, University of Oxford, Oxford, UK.
Warneford Hospital, Oxford Health NHS Foundation Trust, Oxford, UK.
Aust N Z J Psychiatry. 2020 Jan;54(1):29-45. doi: 10.1177/0004867419883341. Epub 2019 Nov 15.
Ketamine may reduce suicidal ideation in treatment-resistant depression. But it is not known how quickly this occurs and how long it persists. We undertook a systematic review and meta-analysis to determine the short- and long-term effectiveness of ketamine for suicidality.
CENTRAL, EMBASE, Medline, and PsycINFO were searched until 12 December 2018. Randomised controlled trials of ketamine or esketamine reporting data on suicidal ideation, self-harm, attempted or completed suicide in adults diagnosed with any psychiatric disorder were included. Two reviewers independently extracted data, and certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation tool. Standardised mean difference was used for continuous outcomes.
Twenty-five reports from 15 independent trials, with a total of 572 participants diagnosed with predominately affective disorders, were included. The evidence was rated moderate to low. In most trials, ketamine was administered at 0.5 mg/kg via a single intravenous infusion over a 30- to 45-minute period. Only a single trial of intranasal esketamine was identified. At 4 hours post-infusion, treatment with ketamine was associated with a significant reduction in suicidal ideation scores (standardised mean difference = -0.51, 95% confidence interval = [-1.00, -0.03]), which persisted until 72 hours post-infusion (time points between 12 and 24 hours: standardised mean difference = -0.63, 95% confidence interval = [-0.99, -0.26]; between 24 and 72 hours: standardised mean difference = -0.57, 95% confidence interval = [-0.99, -0.14]), but not thereafter. However, there was marked heterogeneity of results. In a single trial of esketamine, marginal effects on suicidal ideation were observed. In terms of actual suicidal behaviour, there were virtually no data on effects of ketamine or esketamine.
A single infusion of ketamine may have a short-term (up to 72 hours) beneficial impact on suicidal thoughts. While confirmation of these results in further trials is needed, they suggest possible use of ketamine to treat acute suicidality. Means of sustaining any anti-suicidal effect need to be found.
氯胺酮可能会降低治疗抵抗性抑郁症患者的自杀意念。但是，目前尚不清楚这种效果出现的速度有多快以及持续时间有多长。我们进行了一项系统评价和荟萃分析，以确定氯胺酮治疗自杀意念的短期和长期效果。
检索了 CENTRAL、EMBASE、Medline 和 PsycINFO，直到 2018 年 12 月 12 日。纳入了报告氯胺酮或 Esketamine 治疗成人任何精神障碍患者自杀意念、自残、自杀未遂或自杀完成数据的随机对照试验。两位评审员独立提取数据，并使用推荐评估、制定与评估工具评估证据的确定性。使用标准化均数差表示连续结果。
共纳入了 15 项独立试验的 25 份报告，共有 572 名被诊断为主要为情感障碍的患者。证据质量被评为中低。在大多数试验中，氯胺酮以 0.5mg/kg 的剂量通过 30-45 分钟的单次静脉输注给药。仅确定了一项鼻内 Esketamine 的试验。输注后 4 小时，氯胺酮治疗与自杀意念评分的显著降低相关（标准化均数差=-0.51，95%置信区间=-1.00，-0.03），这种降低持续到输注后 72 小时（12-24 小时之间的时间点：标准化均数差=-0.63，95%置信区间=-0.99，-0.26；24-72 小时之间的时间点：标准化均数差=-0.57，95%置信区间=-0.99，-0.14），但此后没有。然而，结果存在显著的异质性。在 Esketamine 的一项试验中，观察到对自杀意念的边缘效应。就氯胺酮或 Esketamine 的实际自杀行为而言，几乎没有关于其效果的数据。
单次输注氯胺酮可能对自杀念头产生短期（最长 72 小时）的有益影响。虽然需要进一步的试验来证实这些结果，但它们表明氯胺酮可能用于治疗急性自杀意念。需要找到维持任何抗自杀作用的方法。
