Suicide prevention remains an ongoing challenge, with conventional treatment options falling short.

In this article, we delve into the potential of ketamine combined with psychotherapy as a novel approach, illuminating its unique advantages in reducing suicidal thoughts and behavior.

Suicide as a ‘silent epidemic’

Every year, more than 700,000 people take their lives and many more seriously consider doing so. Teenagers and young adults, particularly those identifying as LGBTQ+, are especially at risk.

Yet despite the alarming statistics, the topic of suicide is often overlooked, earning its label as a ‘silent epidemic’.

What are the existing options?

When it comes to suicide prevention, early and effective interventions are critical for a life-saving approach.

Current treatment options include one or a combination of:

• Monitoring and social support
• Tailored psychotherapy
• Mood-stabilizing drugs, such as lithium and SSRIs

While medications are often prescribed, they come with their own set of challenges.

When Standard Medications Fall Short

Standard medicines often help reduce suicidality, but other factors limit their overall efficacy.

They take too long 

Most standard medications, like SSRIs and lithium, take weeks before a patient experiences any beneficial changes. This presents a challenge in the context of suicide prevention, where timely interventions are crucial.

For people grappling with severe distress, waiting for relief can exacerbate feelings of hopelessness, intensifying the urgency for more immediate solutions.

Troubling side-effects 

Another worry is unwanted side effects. SSRIs and lithium commonly lead to a variety of unwanted changes, like nausea, vomiting, weight gain, and diminished sexual desire/function. This complicates treatment adherence as patients may find that the medication’s benefits don’t outweigh its downsides.

Withdrawals

A third problem is debilitating withdrawal symptoms. Abruptly stopping SSRIs and lithium can cause a number of cognitive and emotional changes, including symptoms of depression, anxiety, and suicidality.

The dilemma is clear: while medications can offer relief, their discontinuation can also, paradoxically, amplify the very risks they aim to treat.

Given these limitations, what sets ketamine apart?

Ketamine as a Promising Alternative

In recent years, ketamine has been recognized as a general treatment for mental health conditions. This includes treating suicidality, which is effective in reducing the intensity and frequency of suicidal thoughts and behavior. 

Because ketamine offers some unique advantages over other existing medicines, it is considered an attractive alternative.

Fast-acting changes

Ketamine has the ability to provide rapid relief. Patients can experience decreases in suicidal ideation within 24 hours of ketamine treatment, with some studies showing beneficial effects as soon as 40 minutes.

This contrasts with the delayed action of standard treatments, underscoring ketamine’s potential in situations of psychiatric emergency. 

Lasting benefits

Another advantage of ketamine treatment is its sustained efficacy. Unlike standard medications, ketamine treatment can provide robust and prolonged therapeutic benefits after just a single dose.

Patients have reported reductions in suicidal thoughts and an uplifted mood that lasts between three days and up to a week. These enduring benefits make ketamine not only a short-term crisis intervention tool but also a promising option in ongoing suicide prevention efforts.

Ketamine and the Brain: How Does Ketamine Reduce Suicidality?

The exact mechanism underlying ketamine’s effects is not fully known, but scientists suspect that it may have something to do with glutamate.

Glutamate is our brain’s main excitatory neurotransmitter. It enhances brain immunity and helps us learn and remember things. However, too much of it can lead to mood swings and depressive symptoms.

Let’s delve deeper into this mechanism.

NMDA receptors and the role of glutamate

Ketamine acts by blocking N-methyl-D aspartate (NMDA) receptors, which play a major role in regulating glutamate.

In people experiencing suicidal feelings, the normal flow of glutamate signaling may be disrupted. Ketamine is thought to contribute to mood stabilization by restoring this balance.

Tapping into the brain’s immune response

Another key insight into how ketamine works might be through glutamate’s role in the brain’s inflammatory processes.

People with suicidal behavior show elevated inflammation markers, which correlate with increased glutamate signaling. This has led researchers to speculate that ketamine’s therapeutic potential comes from its anti-inflammatory properties, which are driven by its inhibiting action on NMDA receptors.

Some of the relief patients experience after using ketamine could be attributed to these processes.

Combining Ketamine with Therapeutic Support

Ketamine offers some clear benefits, but coupling it with psychological guidance can provide a more comprehensive approach to mental health.

The importance of professional support and care

When it comes to improving mental well-being, combining medication with psychotherapy is consistently better than medication alone. This is no different with ketamine, as the inclusion of therapeutic support (‘ketamine-assisted therapy’) is an especially effective approach for addressing psychological health problems. 

Beyond its neurological effects, ketamine’s unique property of inducing transformative states of consciousness can help soothe the deep-seated emotional distress in patients.

A well-rounded approach with both ketamine and therapeutic guidance ensures that patients not only find relief from their symptoms but also acquire tools and insights to navigate future challenges.

A Case Study Demonstrating Usefulness

How does this combined approach play out in real-life scenarios?

A recent case study illustrates the usefulness of ketamine-assisted therapy in suicide prevention. It describes a 37-year-old man in crisis, reporting severe depression, anhedonia, and suicidal thoughts and behaviors. He had tried a number of treatment options and felt increasingly hopeless about his situation. 

The combination of ketamine infusions and meaning-centered therapy was carried out as an alternative. Across the therapy, the patient became more and more able to talk about difficult topics, and experienced “increasing feelings of hope, empathy, and love.” By the end, his suicide risk had dropped from a 4 to a 1 (out of a maximum of 5), alongside other significant improvements in mental health.

In a three-month follow-up, the man reported improved quality of life and mental well-being. He also no longer expressed a desire to take his own life.

Weighing the Pros and Cons

The case study above highlights ketamine-assisted therapy’s potential when other methods fail. However, like all treatments, it has its own risks and considerations.

• Possible side effects: Ketamine can lead to side effects, although these almost always fade following the treatment session. The short-term side effects can range from dizziness and nausea to hallucinations and alterations in thoughts and emotions. 
• Varied treatment response: People react differently to ketamine. Some might feel significant relief, while others may notice only slight mood alterations. Similarly, some can find the dissociative influence of ketamine therapeutic, whereas others might find it unsettling.
• Dependence and misuse: There’s a potential of becoming reliant on ketamine, especially if not used under medical supervision. This risk is heightened for individuals with a history of substance abuse.

Ketamine-Assisted Therapy for Suicidality

Navigating the depths of suicidal distress requires compassion and innovative solutions. 

While ketamine is not completely without risks, its transformative effects, especially when combined with psychotherapy, offer a hopeful alternative for people looking beyond standard methods. Give us a call today to learn more about ketamine-assisted therapy for suicidal ideation and how the therapists at the Psychedelica Collective can help you or a loved one.

References

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10. Serafini, G. et al. (2020). A specific inflammatory profile underlying suicide risk? Systematic review of the main literature findings. International journal of environmental research and public health, 17(7), 2393.

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13. Forcén, F. E., Marengo, L., & Behn, M. (2023). Ketamine-assisted meaning-centered psychotherapy for a patient with severe suicidal behavior. Palliative & Supportive Care, 21(2), 362-364.