A systematic review found short-term benefits of intravenous ketamine on suicidal ideation compared with control conditions. The endpoint was different from preventing suicidal acts or deaths.
The reviewed comparisons
Trials used placebo or active controls including midazolam. The review reported a short-term advantage for intravenous racemic ketamine within the first seventy-two hours, while large intranasal esketamine trials did not show the same comparison with placebo.
Control responses were substantial, and dissociative effects could compromise blinding. Routes, regimens, and clinical populations varied.
An active comparator has a defined role
Midazolam can help construct a comparison condition without being established as a suicide-prevention therapy. A trial difference does not establish that the control drug caused deterioration.
The review identified missing evidence on suicidal acts and mortality, longer-term effects, and several populations. It cannot establish that ketamine prevents death or that benzodiazepines are uniformly ineffective for every coexisting symptom. Preserve the actual ideation scale, follow-up interval, route, and control condition when interpreting a favorable short-term result.
Source paper
Original analysis of the supplied journal article, identified as PMC9912570.
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