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Effects of ketamine treatment on suicidal ideation: a qualitative study of patients’ accounts following treatment for depression in a UK ketamine clinic
  1. Karen Lascelles1,2,
  2. Lisa Marzano3,
  3. Fiona Brand1,2,
  4. Hayley Trueman1,
  5. Rupert McShane MD1,4,
  6. Keith Hawton1,2
  1. 1Oxford Health NHS Foundation Trust, Oxford, UK
  2. 2Department of Psychiatry, Centre for Suicide Research, University of Oxford, Oxford, UK
  3. 3Department of Psychology, Middlesex University, London, UK
  4. 4Cochrane Dementia and Cognitive Improvement Group (CDCIG), Nuffield Department of Medicine, University of Oxford, Oxford, UK
  1. Correspondence to Professor Keith Hawton; keith.hawton{at}psych.ox.ac.uk

Abstract

Objective It is recognised that ketamine treatment can reduce suicidal ideation (SI) in people with depression, at least in the short term. However, information is lacking on patients’ perspectives on such effects. Studying these can contribute to greater understanding of the mechanisms underlying impact of ketamine treatment on SI. The aim of this study was to investigate patients’ reports of the impact of treatment on their SI, the duration of effects and possible mechanisms.

Design and setting This qualitative study consisted of semi-structured interviews with patients who had received ketamine treatment for depression. Interview data were analysed thematically.

Participants Fourteen patients (8 females, 6 males, aged 24–64 years) who had received treatment with ketamine for treatment-resistant depression, and had SI at the initiation of treatment. Two participants also had a diagnosis of bipolar type 1 and two of emotionally unstable personality disorder. Eight had a history of self-harm.

Results SI reduced following ketamine treatment in 12 out of 14 participants for periods of a few hours following a single treatment to up to three years with ongoing treatment. Reduction of SI was variable in terms of extent and duration, and re-emergence of suicidal thoughts often occurred when treatment ceased. Participants’ accounts indicated that reduced SI was associated with improved mood and reduced anxiety, as were clarity of thought, focus and concentration, and ability to function. Participants reported experiencing some or all of these effects in various orders of occurrence.

Conclusion Generally, ketamine treatment was experienced as effective in reducing SI, although duration of effects varied considerably. Patients’ perspectives indicated similarities in the mechanisms of reduction in SI, but some differences in their manifestation, particularly in relation to chronology. Experiences of this cohort suggest that reduced anxiety and improvement in ability to think and function were important mechanisms alongside, or in some cases independently of, improvement in mood. Further studies of patients’ experiences are required to gain enhanced understanding of the variability of effects of ketamine on SI and functionality.

  • ketamine
  • suicidal ideation
  • treatment-resistant depression
  • mechanisms
  • self-harm

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Contributors LM, KH and KL designed the study, with the assistance of HT and RM, who both helped recruit the participants. KL collected the data. KL and FB transcribed and analysed the data. KL and KH wrote the first draft of the report. All authors revised the report and approved the final version. KH is an Emeritus National Institute for Health Research senior investigator.

  • Funding This work was supported by the Jim Pullin Trust. RM is supported by the NIHR Oxford Health Biomedical Research Centre and Collaborations for Leadership in Applied Health Research and Care.

  • Competing interests RM has received consulting fees from Janssen.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the South Central Oxford A Research Ethics Committee and the Health Research Authority (Reference No 17/SC/0106).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available.

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