Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK; Oxford Precision Psychiatry Lab, National Institute for Health and Care Research Oxford Health Biomedical Research Centre, Oxford, UK; Oxford Health National Health Service (NHS) Foundation Trust, Warneford Hospital, Oxford, UK.
2 papers in the library · 203 citations · publishing 2019-2026
A single infusion of ketamine may reduce suicidal thoughts in people with treatment-resistant depression within four hours, and the effect can last up to 72 hours. The analysis combined 15 randomized controlled trials with 572 participants, mostly with mood disorders. At four hours after infusion, suicidal ideation scores dropped significantly (standardized mean difference -0.51), and the reduction persisted through 72 hours (standardized mean difference -0.57 to -0.63 at different intervals) but not beyond. Results varied widely across studies, and evidence quality was moderate to low. There were almost no data on whether ketamine prevents actual suicide attempts or self-harm. Further trials are needed to confirm these findings and find ways to sustain the anti-suicidal effect.
This preregistration describes an update and extension of a meta-analysis examining ketamine and esketamine for adults with treatment-resistant major depressive disorder. The project is nested within a larger network meta-analysis of next-step strategies for treatment-resistant depression. It restricts interventions to ketamine and esketamine regimens versus placebo, structures outcomes into three time windows (24–72 hours, 1–3 weeks, and 4–12 weeks), and pools results using pairwise random-effects meta-analyses rather than network meta-analysis due to expected lack of direct comparisons between treatment nodes. Short-term outcomes will be extracted from longer-term trials. Subgroup and meta-regression analyses are exploratory.