Molecular Psychiatry
September 7, 2022
Rebecca B Price, Nicholas Kissel, Andrew Baumeister et al.
80 citations
Ketamine given intravenously rapidly reduces depressive symptoms, with effects lasting at least a week. In an analysis of 17 randomized controlled trials with 809 participants, the benefit over placebo was larger for patients who had already failed two or more prior antidepressant trials. However, no patient-level clinical or demographic characteristics—such as age, sex, or diagnosis—could predict who would respond best, limiting the ability to personalize ketamine prescriptions. The findings confirm ketamine's broad effectiveness for depression but show that precision medicine approaches cannot yet guide treatment decisions.
The international journal of neuropsychopharmacology
April 1, 2024
Sumra Sajid, Hanga C Galfalvy, John G Keilp et al.
9 citations
In a randomized, midazolam-controlled trial of 40 suicidal, depressed participants given intravenous ketamine, acute dissociative and psychotomimetic effects were not associated with changes in suicidal ideation or depressive symptoms from before to after infusion. Norketamine showed a trend-level, moderate inverse correlation with dissociative symptoms on Day 1 post-injection, suggesting dissociation may be more an effect of the parent drug. Dehydronorketamine correlated with dissociative symptoms at multiple time points. No evidence was found that ketamine's acute, transient dissociative or psychotomimetic effects contribute to its antidepressant or anti-suicidal actions.
Translational psychiatry
February 6, 2025
Sumra Sajid, J John Mann, Michael F Grunebaum
3 citations
Ketamine and its enantiomers can reduce suicidal thoughts, but the effects are short-lived and vary by dose and route of administration. A systematic review of 16 clinical trials since 2020 found that multiple intravenous doses of ketamine or S-ketamine reduced suicidal ideation for several days to weeks, while single doses had shorter, less consistent effects. Intranasal and single intravenous doses produced less reliable results. R-ketamine showed fewer side effects but requires more research. No studies measured suicidal behavior as an outcome. The review highlights the need for personalized treatment and notes limitations such as small samples and study heterogeneity.
Journal of affective disorders
November 1, 2026
Tse-Hwei Choo, Hanga C Galfalvy, John G Keilp et al.
A midazolam-controlled trial of intravenous ketamine for suicidal depressed patients found that ketamine rapidly reduced suicidal ideation within 24 hours. An exploratory analysis measured saliva cortisol awakening response at baseline and 24 hours after infusion. Waking cortisol significantly increased 24 hours after ketamine treatment. The increase in waking cortisol from baseline to post-infusion showed a small to medium, nonsignificant correlation with decreased suicidal ideation. These preliminary results, pending replication, align with evidence that moderate cortisol increases may enhance stress-resilience.