OBJECTIVE Suicide is a public health crisis with limited treatment options. The authors conducted a systematic review and individual participant data meta-analysis examining the effects of a single dose of ketamine on suicidal ideation. METHOD Individual participant data were obtained from 10 of 11 identified comparison intervention studies that used either saline or midazolam as a control treatment. The analysis included only participants who had suicidal ideation at baseline (N=167). A one-stage, individual participant data, meta-analytic procedure was employed using a mixed-effects, multilevel, general linear model. The primary outcome measures were the suicide items from clinician-administered (the Montgomery-Åsberg Depression Rating Scale [MADRS] or the Hamilton Depression Rating Scale [HAM-D]) and self-report scales (the Quick Inventory of Depressive Symptomatology-Self Report [QIDS-SR] or the Beck Depression Inventory [BDI]), obtained for up to 1 week after ketamine administration. RESULTS Ketamine rapidly (within 1 day) reduced suicidal ideation significantly on both the clinician-administered and self-report outcome measures. Effect sizes were moderate to large (Cohen's d=0.48-0.85) at all time points after dosing. A sensitivity analysis demonstrated that compared with control treatments, ketamine had significant benefits on the individual suicide items of the MADRS, the HAM-D, and the QIDS-SR but not the BDI. Ketamine's effect on suicidal ideation remained significant after adjusting for concurrent changes in severity of depressive symptoms. CONCLUSIONS Ketamine rapidly reduced suicidal thoughts, within 1 day and for up to 1 week in depressed patients with suicidal ideation. Ketamine's effects on suicidal ideation were partially independent of its effects on mood, although subsequent trials in transdiagnostic samples are required to confirm that ketamine exerts a specific effect on suicidal ideation. Additional research on ketamine's long-term safety and its efficacy in reducing suicide risk is needed before clinical implementation.

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单剂量静脉注射氯胺酮对自杀意念的影响：系统评价和个体参与者数据的荟萃分析。

目的自杀是一种公共卫生危机，治疗选择有限。作者进行了系统的综述，并对参加者的个人数据进行了荟萃分析，研究了单剂量氯胺酮对自杀意念的影响。方法个人参与者数据来自11项经鉴定的比较干预研究，其中10项使用生理盐水或咪达唑仑作为对照治疗。该分析仅包括基线时有自杀意念的参与者（N = 167）。采用混合效应，多层次，通用线性模型进行单阶段，单项参与者数据的荟萃分析。主要结局指标是临床医生管理的自杀项目（蒙哥马利-阿斯伯格抑郁量表[MADRS]或汉密尔顿抑郁量表[HAM-D]）和自我报告量表（抑郁症症状自我快速调查表） [QIDS-SR]或贝克抑郁量表[BDI]），在服用氯胺酮后长达1周获得。结果氯胺酮在临床医生管理的和自我报告的结局指标中均迅速（在1天之内）显着降低了自杀意念。在给药后的所有时间点，效应大小为中到大（Cohen d = 0.48-0.85）。敏感性分析表明，与对照治疗相比，氯胺酮对MADRS，HAM-D和QIDS-SR的各个自杀项目具有显着的益处，但对BDI则没有影响。氯胺酮 在调整抑郁症状严重程度的同时变化后，对自杀意念的影响仍然很显着。结论氯胺酮在抑郁症患者中具有自杀观念，可在1天之内和长达1周的时间内迅速降低其自杀念头。氯胺酮对自杀意念的影响部分独立于其对情绪的影响，尽管需要在转诊样本中进行后续试验以确认氯胺酮对自杀意念具有特定作用。在临床实施之前，需要进一步研究氯胺酮的长期安全性及其降低自杀风险的功效。患有自杀意念的抑郁症患者在1天内最多1周内可以接受治疗。氯胺酮对自杀意念的影响部分独立于其对情绪的影响，尽管需要在转诊样本中进行后续试验以确认氯胺酮对自杀意念具有特定作用。在临床实施之前，需要进一步研究氯胺酮的长期安全性及其降低自杀风险的功效。患有自杀意念的抑郁症患者在1天内最多1周内可以接受治疗。氯胺酮对自杀意念的影响部分独立于其对情绪的影响，尽管需要在转诊样本中进行后续试验以确认氯胺酮对自杀意念具有特定作用。在临床实施之前，需要进一步研究氯胺酮的长期安全性及其降低自杀风险的功效。