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Ketamine's rapid antisuicidal effects are not attenuated by Buprenorphine
Avinash Hosanagar1, Andrew Schmale2, Andrew LeBlanc1
1University of Michigan, Department of Psychiatry, Ann Arbor, Michigan, United States; Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, United States.
Journal of Affective Disorders
|January 8, 2021
Summary
Ketamine rapidly improved suicidal thoughts in a patient with treatment-resistant depression, even while on buprenorphine. This suggests ketamine
Area of Science:
- Neuroscience
- Psychiatry
- Pharmacology
Background:
- Ketamine demonstrates rapid antidepressant and antisuicidal effects, prompting significant clinical interest.
- Concerns exist regarding ketamine's mechanism of action, with some studies suggesting involvement of opioid pathways.
- Previous research indicated that naltrexone, an opioid antagonist, could block ketamine's antisuicidal effects.
Observation:
- A case study involved a patient with treatment-refractory depression and active suicidal ideation, also managed with buprenorphine for pain.
- The patient received intravenous ketamine treatment.
- Rapid improvement in suicidal thoughts was observed following ketamine administration.
Findings:
- Ketamine treatment led to a decrease in suicidal ideations after the first session and complete resolution after the second.
- These positive effects were maintained while the patient continued buprenorphine therapy.
- Buprenorphine did not appear to block the antisuicidal effects of ketamine in this case.
Implications:
- Ketamine treatment may be safely administered in controlled settings to patients with substance use disorders or chronic pain who are on buprenorphine.
- The findings suggest that non-opioid mechanisms might underlie ketamine's antidepressant efficacy and its rapid impact on suicidal ideation.
- This case challenges the exclusive opioid-pathway hypothesis for ketamine's antisuicidal action.
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