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Suicide, a conversation

Suicide is a public health issue that is plagued by stigma, myth and secrecy. It is however, a public health issue which afflicts a great number of families globally. The World Health Organization (WHO) reports that 800,000 people die every year due to suicide. This is the equivalent on one person every forty seconds. Many more attempt suicide, in fact indications are that for every death by suicide, there are 20 others who have attempted suicide (World Health Organization, 2018). Suicide is not a health issue that afflicts a specific age group, gender, or race. It occurs throughout the lifespan and is a global phenomenon.

Worldwide, suicide accounts for 1.4% of all deaths (World Health Organization, 2018). In 2015, of the top twenty causes of death, by suicide was 17th. Following were death by birth trauma, liver cancer, stomach cancer, Colo-rectal cancer and Alzheimer’s /Dementia respectively. Alzheimer’s being the 21st however, it’s significant to mention as it illustrates the alarming rate of deaths by suicide in comparison (Worldlife Expectancy, 2017)

In the United States, according to the Centers for Disease Control and Prevention (CDC) in 2017 suicide was the tenth leading cause of death in the United States, claiming 42, 826 lives. In 2015, there were more suicides 44, 193 than homicides which numbered 17,793.

Some alarming statistics:

• Suicide is the third leading cause of death for children and adolescents between the ages of 10 and 14

• Suicide is the second leading cause of death for teens and young adults between the ages of 15 and 34

• In middle adulthood it is the 3rd leading cause of death,

• Between the ages of 55-64 it is the 7th leading cause of death and

• Age 65 and over it is the 14th leading cause of death

• (CDC, 2016)

In Arizona there is one suicide every 7 hours and it is the 8th leading cause of death (American Foundation For Suicide Prevention, 2015).

• Recently, ketamine has been shown to have a rapid effect on depressive symptoms and suicidal ideation after a single dose.891011 A meta-analysis12 showed a beneficial effect on suicidal ideation scores within 4 hours after infusion, lasting for at least the first 72 hours. Of note, a recent review of the literature suggested that intravenous ketamine has a better effect than intranasal esketamine.13 Previous studies, however, were subject to several methodological limitations. Firstly, the suicidal risk was often poorly measured (eg, with one single item of a depression scale). Secondly, response (usually defined as a 50% score reduction on a scale) was the most common outcome rather than remission (that is, complete absence of suicidal ideas). Thirdly, samples were usually small. Fourthly, most studies were conducted in unipolar disorder with limited knowledge about the effect in bipolar disorder, despite the high suicide risk,14 and in non-mood disorders. Finally, the psychophysiological mechanisms of action remain poorly understood. Notably, it is now established that mental pain contributes to an increased risk of suicidal ideas and acts,15 suggesting that suicidal acts aim to put an end to unbearable mental pain. Whether the antalgic effects of ketamine contribute to its anti-suicidal effects remains to be tested.

Ketamine for the acute treatment of severe suicidal ideation: double blind, randomised placebo controlled trial

BMJ 2022; 376 doi: (Published 02 February 2022)Cite this as: BMJ 2022;376:e06719

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