ETUDE RECHERCHE Le suicide a de nombreux visages, tout comme la kétamine: un examen narratif des actions antisuicidaires de la kétamine.

Suicide Has Many Faces, So Does Ketamine: a Narrative Review on Ketamine's Antisuicidal Actions.

Lengvenyte A ^1,2, Olié E ^1,3, Courtet P ^4,5.

1 Department of Psychiatric Emergency & Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France.

2 Faculty of Medicine, Institute of Clinical Medicine, Psychiatric Clinic, Vilnius University, Vilnius, Lithuania.

3 Neuropsychiatry, Epidemiological and Clinical Research, INSERM, University of Montpellier, Montpellier, France.

4 Department of Psychiatric Emergency & Acute Care, Lapeyronie Hospital, CHU Montpellier, Montpellier, France. philippe.courtet@umontpellier.fr.

5 Neuropsychiatry, Epidemiological and Clinical Research, INSERM, University of Montpellier, Montpellier, France. philippe.courtet@umontpellier.fr.

Curr Psychiatry Rep. 2019 Dec 3

PURPOSE OF REVIEW:

Suicidal behaviours are a challenge for a medical system and public health, partly due to the current lack of evidence-based, effective, rapid tools for suicidal crisis management. Ketamine and its enantiomer esketamine have raised hopes regarding this issue in the recent years. However, their efficacy in suicidal behaviours and mechanisms for it remain a topic of debate.

RECENT FINDINGS:

Subanesthetic ketamine doses rapidly, albeit transiently decrease suicidal ideation, with effects emerging within an hour and persisting up to a week. Current evidence points to various and not necessarily exclusive mechanisms for ketamine's antisuicidal action, including effects on neuroplasticity, inflammation, reward system and pain processing. Ketamine rapidly decreases suicidal ideation, but whether it leads to meaningful clinical outcomes past 1 week is unclear. Multiple putative mechanisms drive ketamine's antisuicidal action. Future studies will have to show long-term ketamine treatment outcomes and further elucidate its mechanisms of action.

KEYWORDS:

Anhedonia; Inflammation; Ketamine; Neuronal plasticity; Suicidal ideation; Suicide

 

https://www.ncbi.nlm.nih.gov/pubmed/31797066