Suizidpräventive Effekte von Ketamin und Esketamin

ZUSAMMENFASSUNG

Ketamin und Esketamin werden als rasch und stark wirksame Mittel zur Reduktion von Depressivität und Suizidalität beschrieben. Dieser Beitrag gibt einen Überblick zur Wirksamkeit von Ketamin und Esketamin zur Reduktion von suizidalen Gedanken und Handlungen, basierend auf randomisierten kontrollierten Studien, die bis Dezember 2021 publiziert wurden. Für Ketamin gibt es Hinweise für eine beträchtliche Reduktion von Suizidgedanken, aber nur in den ersten 3 Tagen und die tatsächliche Effektstärke ist aufgrund der Schätzunsicherheit ungewiss. Für suizidale Handlungen fehlen zudem Daten. Die wenigen, aber qualitativ hochwertigeren Studien zu Esketamin fanden bestenfalls schwache Effekte bezüglich Suizidgedanken, auch unter Berücksichtigung der Schätzunsicherheit, und für suizidale Handlungen können keine gesicherten Aussagen getroffen werden. Das Nutzen-Schaden-Verhältnis von Ketamin und Esketamin in der Suizidprävention ist deshalb ungewiss.

ABSTRACT

Ketamine and esketamine are considered to be rapidly and strongly effective in reducing depression and suicidality. In this article, we give an overview about the efficacy of ketamine and esketamine for the reduction of suicidal ideation and behavior. We base our assessment on randomized controlled trials published until December 2021. For ketamine, there seems to be a substantial reduction of suicide ideation, but only in the first 3 days. The actual size of the effect remains uncertain due to the imprecision in estimates. Furthermore, evidence for suicidal behavior is lacking. For esketamine, the few but qualitatively superior studies found weak effects at best, even when accounting for imprecision of the estimates. No firm conclusions can be drawn regarding suicidal behavior. The benefit-harm ratio of ketamine and esketamine in suicide prevention thus remains uncertain.

Schlüsselwörter

Ketamin - Esketamin - Suizid

Key words

Ketamine - esketamine - suicide

Publication History

Article published online:
04 April 2022

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