Oral ketamine doses promising against chronic suicidality, study finds

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A new study from USC Australia has found that oral doses of ketamine administered in a clinical setting can provide a rapid-acting treatment for chronic suicidality.

The study from USC’s Thompson Institute, published in Translational Psychiatry, showed that within the first six weeks, 69 percent of participants achieved a clinical reduction in suicide ideation.

Principal investigator psychiatrist Dr Adem Can, who led the research at USC, said the findings were significant, given the difficulty of treating chronic suicidality, and had the potential to save lives.

“On average, patients experienced a significant reduction in suicide ideation, from a high level before the trial to below the clinical threshold by week six of the trial,” Dr Can said.

“In medicine, this response rate is significant, particularly given it was experienced by patients with chronic suicidality, which can be difficult to treat.

“These patients had lived with suicidality for a very long time and presented a range of psychiatric conditions, including mood, anxiety and personality disorders, and many of them had lost hope of recovery.”

Ketamine has been shown to influence the firing of the brain, turning uncoordinated and overactive brain networks into ordered and precise networks that function more effectively.

Anti-depressant medications are a common treatment for suicidality but can have significant limitations for some patients.

Dr Can said the study successes were consistent with those shown in intravenous ketamine trials, in which the ketamine was administered by injection, typically in a hospital setting.

“Intravenous administration, however, is invasive, expensive and carries a higher chance of adverse reactions due to its injection straight into the blood stream. So logistically it is a lot easier and faster to clinically administer an oral dose,” he said.

While the findings support the feasibility of oral ketamine as a treatment for chronic suicidality, the researchers suggest that further study is needed to test efficacy by using randomised control groups.

USC Thompson Institute Director and study supervisor Professor Jim Lagopoulos has been studying the potential therapeutic benefits of ketamine for 20 years, and said the findings were an exciting development.

“The longer you have a particular condition, the more resistant it can become to treatment,” Professor Lagopoulos said.

“We also had a very complex group of patients with a variety of conditions such as depression, anxiety, borderline personality disorder – all factors that can increase your potential for suicidality – yet the treatment still worked across the group.

“This means the trial group was representative of the community we are serving, where suicidality is often accompanied by one or more other conditions. So results like these across the spectrum are very encouraging.”

The Thompson Institute, which was officially opened on the Sunshine Coast in 2017, delivers clinical services, outreach and related research from the same building.

“Our clinicians are informing our researchers of those vexing clinical questions they don’t have answers to, and then it is up to our researchers to come up with answers and translate this back to the clinicians to directly help the patients,” Professor Lagopoulos said.

“That all happens under one roof, where we are working synergistically towards those common goals, and this study is just one example of how we can pivot the research directly back to helping patients.”

He said the study also demonstrated the range in which dosage could be adjusted according to a patient’s physiology and tolerance to the treatment, while still reducing suicidality.

Patients were monitored closely and supervised after treatment, with regular follow-up during treatment. Half of participants still noted significant improvement four weeks after treatment had ceased.  

 
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