Evidence map›Paper›PMID 28969441›Full record

SynthesisThe American journal of psychiatry2018

The Effect of a Single Dose of Intravenous Ketamine on Suicidal Ideation: A Systematic Review and Individual Participant Data Meta-Analysis.

Samuel T Wilkinson, Elizabeth D Ballard, Michael H Bloch, Sanjay J Mathew, James W Murrough, Adriana Feder, Peter Sos, Gang Wang, Carlos A Zarate, Gerard Sanacora

5 registry-linked trialsAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in The American journal of psychiatry, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 5 registered trials, which are not on this map. Cited by 311 papers, 15 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
311citing papers in PubMed, 15 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT04260607 phase3terminatednot on this mapstarted 2020, after this paper: background citation

Initiating Ketamine in Acutely Suicidal Patients in the Emergency Department

TypeinterventionalSponsorNaval Medical Center Camp LejeuneRan2020 to 2022Enrolled1ConditionsSuicide, Suicide Threat, Depression SevereArmsKetamine Hydrochloride, Normal saline
NCT04399070 naunknown statusnot on this mapstarted 2020, after this paper: background citation

Effect of S-ketamine on Depressed Patients Undergoing Electroconvulsive Therapy-a Randomized, Double-blind, Controlled Clinical Study

TypeinterventionalSponsorYan QiuRan2020 to 2021Enrolled150ConditionsDepression, Bipolar, Depression, Unipolar, Major Depressive Disorder, Manic-Depressive - Now DepressedArmsS-ketamine, ketamine, saline
NCT04658420 phase2unknown statusnot on this mapstarted 2021, after this paper: background citation

A Single Ketamine Infusion Combined With Music for Suicidal Ideation During a Depressive Episode: A Randomized Open Label Clinical Trial

TypeinterventionalSponsorThe University of Texas Health Science Center at TylerRan2021 to 2023Enrolled200ConditionsSuicidal Ideation, Depressive EpisodeArmsKetamine Hydrochloride, Music
NCT06957704 phase3not yet recruitingnot on this mapstarted 2025, after this paper: background citation

Evaluation of the Efficacy and Safety of Subcutaneous Ketamine in the Treatment of Depressive Episode With Suicidal Ideation and/or Behavior in Adolescents

TypeinterventionalSponsorFederal University of São PauloRan2025 to 2028Enrolled60ConditionsDepressive Disorder, Suicidal IdeasArmsketamine, Midazolam
NCT07120477 phase4suspendednot on this mapstarted 2026, after this paper: background citation

Esketamine Versus Crisis Response Planning Versus Enhanced Treatment as Usual for Suicide Prevention: A Pragmatic Randomized Trial in a Brazilian Municipality (SAVE)

TypeinterventionalSponsorUniversity of Sao PauloRan2026 to 2029Enrolled468ConditionsSuicide Prevention, Ketamine, Crisis Response PlanArmsIntravenous Esketamine, Crisis Response Planning intervention (structures safety planning)
3 · Its place in the literature

Who cites it

311 citing papers in PubMed, 15 syntheses or guidelines pooled it.

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  12. Ketamine for Bipolar Depression: A Systematic Review.The international journal of neuropsychopharmacology · 2021
    Pooled it
  13. Interventions for self-harm in children and adolescents.The Cochrane database of systematic reviews · 2021
    Pooled it
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  15. Pharmacological interventions for self-harm in adults.The Cochrane database of systematic reviews · 2021
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251 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

10 authors.

Samuel T WilkinsonFrom the Department of Psychiatry and the Child Study Center, Yale School of Medicine, New Haven, Conn.; the Experimental Therapeutics and Pathophysiology Branch, NIMH, Bethesda, Md.; the Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston; the Michael E. Debakey VA Medical Center, Houston; the Mood and Anxiety Disorders Program, Icahn School of Medicine at Mount Sinai, New York; the Department of Psychiatry, First Faculty of Medicine, Charles University, Prague, Czech Republic; and the Beijing Anding Hospital, Capital University of Medical Sciences, Beijing.
Elizabeth D BallardFrom the Department of Psychiatry and the Child Study Center, Yale School of Medicine, New Haven, Conn.; the Experimental Therapeutics and Pathophysiology Branch, NIMH, Bethesda, Md.; the Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston; the Michael E. Debakey VA Medical Center, Houston; the Mood and Anxiety Disorders Program, Icahn School of Medicine at Mount Sinai, New York; the Department of Psychiatry, First Faculty of Medicine, Charles University, Prague, Czech Republic; and the Beijing Anding Hospital, Capital University of Medical Sciences, Beijing.
Michael H BlochFrom the Department of Psychiatry and the Child Study Center, Yale School of Medicine, New Haven, Conn.; the Experimental Therapeutics and Pathophysiology Branch, NIMH, Bethesda, Md.; the Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston; the Michael E. Debakey VA Medical Center, Houston; the Mood and Anxiety Disorders Program, Icahn School of Medicine at Mount Sinai, New York; the Department of Psychiatry, First Faculty of Medicine, Charles University, Prague, Czech Republic; and the Beijing Anding Hospital, Capital University of Medical Sciences, Beijing.
Sanjay J MathewFrom the Department of Psychiatry and the Child Study Center, Yale School of Medicine, New Haven, Conn.; the Experimental Therapeutics and Pathophysiology Branch, NIMH, Bethesda, Md.; the Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston; the Michael E. Debakey VA Medical Center, Houston; the Mood and Anxiety Disorders Program, Icahn School of Medicine at Mount Sinai, New York; the Department of Psychiatry, First Faculty of Medicine, Charles University, Prague, Czech Republic; and the Beijing Anding Hospital, Capital University of Medical Sciences, Beijing.
James W MurroughFrom the Department of Psychiatry and the Child Study Center, Yale School of Medicine, New Haven, Conn.; the Experimental Therapeutics and Pathophysiology Branch, NIMH, Bethesda, Md.; the Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston; the Michael E. Debakey VA Medical Center, Houston; the Mood and Anxiety Disorders Program, Icahn School of Medicine at Mount Sinai, New York; the Department of Psychiatry, First Faculty of Medicine, Charles University, Prague, Czech Republic; and the Beijing Anding Hospital, Capital University of Medical Sciences, Beijing.
Adriana FederFrom the Department of Psychiatry and the Child Study Center, Yale School of Medicine, New Haven, Conn.; the Experimental Therapeutics and Pathophysiology Branch, NIMH, Bethesda, Md.; the Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston; the Michael E. Debakey VA Medical Center, Houston; the Mood and Anxiety Disorders Program, Icahn School of Medicine at Mount Sinai, New York; the Department of Psychiatry, First Faculty of Medicine, Charles University, Prague, Czech Republic; and the Beijing Anding Hospital, Capital University of Medical Sciences, Beijing.
Peter SosFrom the Department of Psychiatry and the Child Study Center, Yale School of Medicine, New Haven, Conn.; the Experimental Therapeutics and Pathophysiology Branch, NIMH, Bethesda, Md.; the Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston; the Michael E. Debakey VA Medical Center, Houston; the Mood and Anxiety Disorders Program, Icahn School of Medicine at Mount Sinai, New York; the Department of Psychiatry, First Faculty of Medicine, Charles University, Prague, Czech Republic; and the Beijing Anding Hospital, Capital University of Medical Sciences, Beijing.
Gang WangFrom the Department of Psychiatry and the Child Study Center, Yale School of Medicine, New Haven, Conn.; the Experimental Therapeutics and Pathophysiology Branch, NIMH, Bethesda, Md.; the Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston; the Michael E. Debakey VA Medical Center, Houston; the Mood and Anxiety Disorders Program, Icahn School of Medicine at Mount Sinai, New York; the Department of Psychiatry, First Faculty of Medicine, Charles University, Prague, Czech Republic; and the Beijing Anding Hospital, Capital University of Medical Sciences, Beijing.
Carlos A ZarateFrom the Department of Psychiatry and the Child Study Center, Yale School of Medicine, New Haven, Conn.; the Experimental Therapeutics and Pathophysiology Branch, NIMH, Bethesda, Md.; the Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston; the Michael E. Debakey VA Medical Center, Houston; the Mood and Anxiety Disorders Program, Icahn School of Medicine at Mount Sinai, New York; the Department of Psychiatry, First Faculty of Medicine, Charles University, Prague, Czech Republic; and the Beijing Anding Hospital, Capital University of Medical Sciences, Beijing.
Gerard SanacoraFrom the Department of Psychiatry and the Child Study Center, Yale School of Medicine, New Haven, Conn.; the Experimental Therapeutics and Pathophysiology Branch, NIMH, Bethesda, Md.; the Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston; the Michael E. Debakey VA Medical Center, Houston; the Mood and Anxiety Disorders Program, Icahn School of Medicine at Mount Sinai, New York; the Department of Psychiatry, First Faculty of Medicine, Charles University, Prague, Czech Republic; and the Beijing Anding Hospital, Capital University of Medical Sciences, Beijing.

Funding

Yale Clinical and Translational Science Award (U Component)UL1TR001863 · NCATS · YALE UNIVERSITY · PI John H. Krystal, LUCILA OHNO-MACHADO · 2016 to 2026
$102.9M
Glutamatergic Modulators for Rapid & Sustained Antidepressant EffectZIAMH002857 · NIMH · NATIONAL INSTITUTE OF MENTAL HEALTH · PI ZARATE, CARLOS · 2009 to 2025
$55.0M
Research Training for Medical Students & Physician-Scientists in Child PsychiatryR25MH077823 · NIMH · YALE UNIVERSITY · PI ANDRES S MARTIN · 2006 to 2026
$4.0M
Research Training in Functional Disability InterventionsT32MH062994 · NIMH · YALE UNIVERSITY · PI BELL, MORRIS D. · 2002 to 2017
$3.0M
Glutamatergic Modulators--Rapid Sustained AntidepressantZ01MH002857 · NIMH · NATIONAL INSTITUTE OF MENTAL HEALTH · PI MANJI, HUSSEINI K · 2005 to 2008
$621k
RR&D Senior Research Career Scientist AwardIK6RX002458 · VA · VA CONNECTICUT HEALTHCARE SYSTEM · PI MORRIS D. BELL · 2017 to 2026
–
Intramural NIH HHS Z01 MH002857Intramural NIH HHS ZIA MH002857NCATS NIH HHS UL1 TR001863NIMH NIH HHS L30 MH111000NIMH NIH HHS R25 MH077823NIMH NIH HHS T32 MH062994RRD VA IK6 RX002458
6 · The paper itself

Abstract

objectiveSuicide is a public health crisis with limited treatment options. The authors conducted a systematic review and individual participant data meta-analysis examining the effects of a single dose of ketamine on suicidal ideation.

methodIndividual participant data were obtained from 10 of 11 identified comparison intervention studies that used either saline or midazolam as a control treatment. The analysis included only participants who had suicidal ideation at baseline (N=167). A one-stage, individual participant data, meta-analytic procedure was employed using a mixed-effects, multilevel, general linear model. The primary outcome measures were the suicide items from clinician-administered (the Montgomery-Åsberg Depression Rating Scale [MADRS] or the Hamilton Depression Rating Scale [HAM-D]) and self-report scales (the Quick Inventory of Depressive Symptomatology-Self Report [QIDS-SR] or the Beck Depression Inventory [BDI]), obtained for up to 1 week after ketamine administration.

resultsKetamine rapidly (within 1 day) reduced suicidal ideation significantly on both the clinician-administered and self-report outcome measures. Effect sizes were moderate to large (Cohen's d=0.48-0.85) at all time points after dosing. A sensitivity analysis demonstrated that compared with control treatments, ketamine had significant benefits on the individual suicide items of the MADRS, the HAM-D, and the QIDS-SR but not the BDI. Ketamine's effect on suicidal ideation remained significant after adjusting for concurrent changes in severity of depressive symptoms.

conclusionsKetamine rapidly reduced suicidal thoughts, within 1 day and for up to 1 week in depressed patients with suicidal ideation. Ketamine's effects on suicidal ideation were partially independent of its effects on mood, although subsequent trials in transdiagnostic samples are required to confirm that ketamine exerts a specific effect on suicidal ideation. Additional research on ketamine's long-term safety and its efficacy in reducing suicide risk is needed before clinical implementation.

Indexed as

Suicidal IdeationAdultDepressionExcitatory Amino Acid AntagonistsFemaleHumansInfusions, IntravenousKetamineLinear ModelsMajor Depressive DisorderMaleMiddle AgedMultilevel AnalysisSelf ReportTreatment OutcomeExcitatory Amino Acid AntagonistsKetamineKetamineMood Disorders-BipolarMood Disorders-UnipolarRapid-Acting AntidepressantsSuicide

Identifiers

PMID28969441
PMCPMC5794524

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.