From the Guidelines
The quickest treatment for suicidal ideation is ketamine infusion, which has been shown to result in rapid improvement of suicidal ideation symptoms within 24 hours. This is based on the most recent and highest quality study available, which found that 55% of patients who received ketamine reported no suicidal ideation after 24 hours and 60% reported that they were no longer having suicidal ideations at 7 days 1.
Key Points to Consider
- Ketamine infused as a single dose (0.5 mg/kg) results in rapid improvement of suicidal ideation symptoms, with benefits beginning within 24 hours of the infusion and continuing for at least 1 week 1.
- Other treatments, such as lithium and clozapine, may also reduce the risk of suicide, but their effects may not be as rapid as ketamine infusion 1.
- Non-pharmacologic interventions, such as cognitive behavioral therapy (CBT), can also be effective in reducing suicidal ideation and behavior, but may not provide immediate relief 1.
Important Considerations
- Any person experiencing suicidal thoughts should be under direct professional supervision until the crisis resolves.
- Immediate safety planning is crucial, including removing access to lethal means, establishing a crisis contact list, and arranging close follow-up care.
- Electroconvulsive therapy (ECT) is another rapid option, typically administered 2-3 times weekly for 6-12 treatments, but its use should be considered on a case-by-case basis.
From the FDA Drug Label
Antidepressant medicines may increase suicidal thoughts or actions in some children, teenagers, and young adults within the first few months of treatment. Call the healthcare provider right away to report new or sudden changes in mood, behavior, thoughts, or feelings.
The quickest treatment of suicidal ideation is not explicitly stated in the drug label. However, it is recommended to call a healthcare provider right away if symptoms of suicidal thoughts or actions occur, especially if they are new, worse, or worrisome.
- Key points:
- Pay close attention to changes in mood, behaviors, thoughts, or feelings, especially when an antidepressant medicine is started or when the dose is changed.
- Keep all follow-up visits with the healthcare provider as scheduled.
- Call the healthcare provider between visits as needed, especially if you have concerns about symptoms. 2
From the Research
Quickest Treatment of Suicidal Ideation
- The quickest treatment of suicidal ideation is a critical issue for clinicians, and several studies have investigated this topic 3, 4, 5, 6, 7.
- A study published in the Journal of Affective Disorders found that during a 12-week naturalistic treatment with antidepressant intervention, 36.4% of patients with significant suicidal ideation were classified as having resolved suicidality 3.
- Another study published in The Journal of Clinical Psychiatry found that combination therapy with olanzapine and lithium or divalproex reduced suicidal ideation in bipolar I disorder mixed-episode patients by 58% within 1 week, and all associated symptom factors within 2 weeks by averages of 31% 4.
- A systematic review and meta-analysis published in Depression and Anxiety found that lithium was associated with a reduction in the odds of suicide compared to active controls and placebo/no lithium in bipolar disorder, and clozapine was associated with a reduction in the odds of suicide in psychotic disorders 5.
- A population-based cohort study published in Neuropsychopharmacology found that SSRI treatment was associated with a reduced risk of suicidal behavior, particularly in the 30 days after treatment initiation, and the risk declined over treatment time 6.
- A study published in Pharmaceuticals analyzed pharmacovigilance data and found that psychiatric adverse drug reactions, including suicidal ideation, suicide attempts, and completed suicides, were associated with SSRI and SNRI drugs, with significant age and gender disparities 7.
Treatment Options
- Antidepressant intervention, such as SSRIs, may be effective in reducing suicidal ideation 3, 6.
- Combination therapy with olanzapine and lithium or divalproex may be effective in reducing suicidal ideation in bipolar I disorder mixed-episode patients 4.
- Lithium may be associated with a reduction in the odds of suicide in bipolar disorder and mixed diagnostic samples 5.
- Clozapine may be associated with a reduction in the odds of suicide in psychotic disorders 5.
Important Considerations
- Close monitoring for suicidal ideation may be needed beyond the initial weeks of treatment and even after a response to antidepressants is observed 3.
- The risk of suicidal behavior may be reduced with SSRI treatment, particularly in the 30 days after treatment initiation, and the risk declines over treatment time 6.
- Psychiatric adverse drug reactions, including suicidal ideation, suicide attempts, and completed suicides, are associated with SSRI and SNRI drugs, with significant age and gender disparities 7.