Ketamine: The Drug That Could Decrease Suicide?

The reality of suicide and mental health issues in the U.S. feels more pressing now than in recent memory. As the 10th-leading cause of death in the country, suicide killed 47,511 people domestically — with 1.38 million documented attempts — in 2019.

Many suspect the ongoing COVID-19 crisis will be linked to more tragic deaths via suicide — the compounding pressures of the pandemic making what for many was an already intolerable situation unsustainable. But, it's too soon to say if this will be the case.

However, recent preliminary research into low-dose ketamine has raised the possibility of using the drug as a rapid-acting treatment for suicidal ideation, and potentially reducing the rate of deaths from suicide, according to a recent paper published in the journal Nature.

Cautious optimism apt about potential ketamine use

In the last year, we've seen a flurry of interest in using ketamine as a way to counteract the symptoms of depression and reduce suicide rates — with media chatter on the potential use of drugs (including psychedelics) rising as if in direct proportion to the general feeling of dismay at the worsening global situation for most of the world's people.

In other words, there's nothing wrong with optimism about the growing interest in using ketamine to combat this rising threat to life and livelihoods — so long as our optimism is accompanied by acutely-observed caution.

Ketamine might help reduce suicide rates

Up to now, most studies have focused on the use of intravenously injected (IV) ketamine. But this port of entry for the drug has limits, especially when compared to the dynamic settings in which the drug may be administered orally.

This is significant in working to treat the growing rate of suicide — which occurs across a broad range of social and economic environments and financial means. But sadly, current studies fall short when it comes to safety and feasibility. 

Roughly 32 adults between 22 and 72 years old (53% female) with chronic suicidal ideation participated in the study — named the Oral Ketamine Trial on Suicidality (OKTOS) — which saw a trial administration of "sub-anesthetic" doses of oral ketamine through a six-week period.

Oral ketamine feasible alternative to other methods

Participants began with a dose of 0.5 milligrams per kilogram (mg/kg) of ketamine, which was raised to a maximum of 3.0 mg/kg. Assessments followed four weeks after the last dose, with the primary measure involving the Beck Scale for Suicide Ideation (BSS), and a secondary check via scales rating "suicidality" and symptoms of depression — in addition to evaluations of well-being and capacity to function.

The study showed a substantial drop in average BSS scores — from high levels of suicidal ideation before the ketamine was applied to the clinical threshold that happened after week six of ketamine doses. A whopping 69% showed clinical improvement within the first six weeks, with 50% achieving a significant improvement by week 10.

These results suggest that orally administering ketamine is a tolerable and feasible alternative treatment to IV ketamine administration for chronic suicidal ideation, and more. While this is promising, we can't emphasize enough the need to take this potentially transformative find with a cold-but-kind grain of salt — since the social, economic, and even political network of systems and forces that bring people to major depression and suicidal ideation are maddeningly complex, dynamic, and likely systemic.

If you are having thoughts of suicide, you can call the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK). You can find a list of additional resources at Speaking of Suicide