Suicidal Ideation Not Related With Psychological Pain After Receiving Ketamine

Suicidal ideation (SI) following a ketamine intervention was not related with hopelessness or psychological pain in the inpatient setting, according to results of a study published in the Journal of Affective Disorders.

Data for this study were sourced from 4 active treatment arms of 4 randomized, controlled trials conducted by the National Institutes of Health in the United States between 2006 and 2018. Inpatients with bipolar disorder (BD) or major depressive disorder (MDD) were randomized to receive intravenous ketamine or saline or intravenous ketamine with oral riluzole or intravenous ketamine with oral placebo.

For this analysis, all individuals (n=108) who received ketamine were evaluated for whether the interaction between psychological pain and hopelessness associated with future SI during the short term (3 days) or long term (11 days) using a random intercept cross-lagged panel model.

Patients with short-term (n=105) and long-term (n=45) follow-up were aged mean 43.12 (SD, 12.36) and 47.96 (SD, 12.33) years, 49.52% and 42.22% were women, 87.62% and 93.33% were White, 70.48% and 100% had MDD, and 36.19% and 38% had a history of suicide attempt, respectively.

The within-subject stability of SI was 0.71 (95% CI, 0.66-0.76) for the short-term cohort and 0.62 (95% CI, 0.51-0.72) for the long-term group.

In the short-term follow-up analysis, SI and hopelessness/psychological pain parameters were moderately elevated after ketamine compared with baseline.

In the long-term analysis, hopelessness and psychological pain elevations after ketamine were related with later evaluations. Hopelessness and psychological pain did not predict later SI but SI moderately predicted future hopelessness and psychological pain (t, -1.81; P =.07).

No associations were observed for other SI risk factors, such as depressed mood, impaired sleep, or anhedonia.

The major limitation of this analysis was that the original studies were not designed to evaluate hopelessness or psychological pain.

The study authors concluded, “Psychological pain and hopelessness were not associated with the reemergence of SI postketamine. These results may be due to limited variability in the data. The reemergence of SI postketamine may also not follow patterns typically seen in nonpharmacologic contexts. Individuals with a history of SI warrant careful monitoring postketamine administration.”

Disclosure: An author declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Ballard ED, Farmer CA, Gerner J, Bloomfield-Clagett B, Park LT, Zarate CA. Prospective association of psychological pain and hopelessness with suicidal thoughts. J Affect Disord. 2022;308:243-248. doi:10.1016/j.jad.2022.04.033