NIMH Supports 8 Interventions for Severe Suicide Risk Including Ketamine, Esketamine

In an effort to reduce the number of suicides in the United States that’s been rising for the past two decades, the National Institute of Mental Health (NIMH) announced it is supporting eight new research projects investigating the feasibility and safety of rapid-acting suicide prevention interventions involving ketamine, esketamine, or transcranial magnetic stimulation (TMS).

Ketamine is a dissociative anesthetic that has been shown to rapidly reduce depressive symptoms in hours or days, as opposed to the weeks or months it takes for traditional antidepressant therapy. Esketamine is a relatively new Food and Drug Administration (FDA)-approved nasal spray version of ketamine for treatment-resistant, severe unipolar major depression. TMS uses magnets to activate specific parts of the brain in order to reduce suicidal thoughts and behaviors. 

The eight suicide prevention programs supported by NIMH include:

• A University of Pittsburgh program investigating a single dose of ketamine treatment compared to standard care alone in patients between the ages of 18 and 65 following a suicide attempt. 
• A Columbia University Medical Center and New York State Psychiatric Institute study examining intramuscular ketamine injection within 24 hours in patients who present to emergency departments with severe suicidal ideation or behavior requiring psychiatric hospitalization. 
• A University of Southwestern Medical Center study of ketamine versus the sedative Midazolam in youth with recent suicidal behavior. 
• A Cleveland Clinic Lerner College of Medicine study pairing a series of ketamine treatments with weekly sessions of a therapy called Collaborative Assessment for the Management of Suicidality for reducing suicide risk in 15- to 24-year-olds who have previously attempted suicide. 
• A Yale Child Study Center investigating four doses of intravenous ketamine over two weeks in teenagers with treatment-resistant depression and suicidal thinking compared to an active control. 
• A Yale University investigating the ability of cognitive-behavioral therapy to extend the anti-suicidality effects of intranasal esketamine in people with major depressive disorder who are hospitalized for suicidal thoughts or a suicide attempt. 
• A Mayo Clinic study examining the safety, feasibility, and clinical effects of sequential bilateral accelerated theta burst stimulation to the prefrontal cortex of adolescents with major depressive disorder. 
• A Stanford University Medical Center study investigating the use of personalized repetitive TMS method called the Stanford Accelerated Intelligence Neuromodulation Therapy for reducing suicidal thoughts in patients hospitalized in psychiatric units. 

 “Despite advances in psychiatric treatments and psychosocial interventions that reduce repeat suicide attempts, there remain few evidence-based interventions that rapidly reduce suicide risk within healthcare settings,” NIMH said in a news release. “The lack of such interventions often means that people at high risk for suicide must be treated in resource-intensive health care settings, such as the emergency department or inpatient settings. Identifying and developing rapid-acting treatments can reduce or eliminate the need for hospitalization and help ‘jumpstart’ the recovery trajectory.”