Ketamine for suicidal ideation

The repurposing of ketamine for use in mental disorders is a noteworthy yet disputed development in psychiatry over the past two decades.12 Ketamine has an antidepressant effect that is unconventionally swift and that does not apparently involve monoaminergic pathways.3 Ketamine could also rapidly reduce suicidal ideation in a way that is at least partially independent from its effect on mood.4

Current treatments for people with acute suicidal ideation are unsatisfactory.5 Holistic approaches involving psychosocial interventions, patient and family education, and hospital admission or community based management with close monitoring are currently the key interventions. However, these strategies might demand weeks of support and are limited by availability of resources. Although only a minority of patients with suicidal ideation go on to attempt suicide,6 many patients experience extreme suffering during emergency presentations. It would therefore be difficult to argue against any new treatment if it were shown to be effective, safe, fast acting, and readily available.

In this context, the linked study by Abbar and colleagues (doi:10.1136/bmj-2021-067194)7 is set to challenge some of our …