Acute Effects of Intravenous Sub-Anesthetic Doses of Ketamine and Intranasal Inhaled Esketamine on Suicidal Ideation: A Systematic Review and Meta-Analysis.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of randomized controlled trials
PubMed 36942150 · doi:10.2147/NDT.S401032
What was done
A systematic review and meta-analysis of parallel randomized controlled trials (RCTs) searched across PubMed, Embase, Ovid, Cochrane, and Web of Science through September 29, 2022. The authors evaluated the acute efficacy, onset, and duration of intravenous sub-anesthetic ketamine and intranasal esketamine on suicidal ideation (SI). The primary outcome was suicide scale score change (measured via SSI, BSS, BDI, or MSSI), calculated as Cohen's d between pre- and post-administration in each group.
What was found
Both IV ketamine and intranasal esketamine significantly reduced suicidal ideation within 4–6 hours and at 24 hours: - IV ketamine demonstrated a large anti-SI effect at 4–6 hours (Cohen's d = 1.16, 95% CI: 0.50, 1.81) and a medium-to-large effect at 24 hours (Cohen's d = 0.95, 95% CI: 0.48, 1.41). - Intranasal esketamine demonstrated a small-to-medium anti-SI effect at 4–6 hours (Cohen's d = 0.26, 95% CI: 0.09, 0.44) and at 24 hours (Cohen's d = 0.30, 95% CI: 0.17, 0.47).
Why it matters
This meta-analysis indicates that both IV ketamine and intranasal esketamine rapidly reduce suicidal ideation within hours, though IV ketamine achieved larger effect sizes across the first 24 hours.
Limits
The abstract does not report the total number of included studies or participants (n). Outcome assessments pooled heterogeneous depression and suicidality scales, and no data beyond 24 hours, safety outcomes, or completed suicide rates were reported.
Cited by
- supports Ketamine administration frequently resolves suicidal ideation within the first few hours.