Palavras-chave
Cetamina
Depressão, Estigmas, Tratamento.
ideacao suicida
Como Citar
Resumo
O suicídio configura um desafio crítico para a saúde pública a ser enfrentado na atualidade por sua alta prevalência. Diante dessa realidade, a ketamina constitui uma possível intervenção medicamentosa na promoção da redução de ideias e comportamentos suicidas. Contudo, essa droga permanece alvo de estudos a fim de esclarecer sua aplicabilidade, efeitos a longo prazo e a sustentabilidade dos benefícios e dos impactos negativos associados. O objetivo desta revisão foi verificar a eficácia e a presença de efeitos adversos relacionados ao uso da ketamina como alternativa terapêutica para a redução da ideação suicida em pacientes com transtornos depressivos graves. Foi realizada uma busca nas bases de dados Pubmed e Biblioteca Virtual em Saúde (BVS) com os descritores “ketamine” e “suicidal ideation”, utilizando o operador booleano “AND”, e foram incluídos artigos publicados entre 2019 e 2024 e artigos do tipo ensaio clínico e ensaio clínico controlado, e excluídos artigos duplicados entre as bases de dados e artigos não relacionados ao tema abordado. Após a leitura e aplicação dos critérios de inclusão e exclusão, 31 artigos foram incorporados ao estudo. Através dos estudos realizados foi evidenciado que a redução na ideação suicida após a administração de ketamina foi observada na maioria dos artigos analisados devido a seu rápido efeito, de maneira a reduzir sintomas suicidas e, consequentemente, o risco iminente de suicídio. Entretanto, é válido ressaltar que essa melhora na suicidalidade não está isenta de complicações, de forma que sintomas dissociativos e efeitos cardíacos foram descritos em associação à infusão desta droga, evidenciando a necessidade de monitorização rigorosa subjacente ao uso da ketamina. Em síntese, a modulação de diretrizes consolidadas para a aplicação desta droga no tratamento de pacientes se faz essencial para a manutenção dos benefícios terapêuticos e mitigação dos riscos. A resolução desses aspectos possibilita a integração da ketamina como uma alternativa segura e eficaz na redução da ideação suicida em pacientes depressivos no contexto de intervenções médicas em emergências.
Referências
- Barbosa, Costa P, Maria R. Depressão e o suicídio. Rev SBPH. 2020; 14(1):233-43.
- Su TP, Cheng Ta Li, Lin WC, Wu HJ, Tsai SJ, Bai YM, et al. A randomized double-blind midazolam-controlled trial of low-dose ketamine infusion in patients with treatment-resistant depression and prominent suicidal ideation. IJNP. 2023 May 31;26(5):331–9.
- Ionescu DF, Bentley KH, Eikermann M, Taylor N, Akeju O, Swee MB, et al. Repeat-dose ketamine augmentation for treatment-resistant depression with chronic suicidal ideation: a randomized, double-blind, placebo-controlled trial. J Affect Disord. 2019 Jan 15; 243: 516–24.
- Moreira LCO, Bastos PRHO. Prevalência e fatores associados à ideação suicida na adolescência: revisão de literatura. Rev Assoc Bras Psicol Esc Educ. 2015 Dec;19(3): 445-53.
- Borges G, Nock MK, Haro Abad JM, Hwang I, Sampson NA, Alonso J, et al. Twelve-month prevalence of and risk factors for suicide attempts in the WHO World Mental Health Surveys. J Clin Psychiatry. 2010 Dec 1;71(12):1617-28.
- Abbar M, Demattei C, El-Hage W, Llorca PM, Samalin L, Demaricourt P, et al. Ketamine for the acute treatment of severe suicidal ideation: double blind, randomised placebo controlled trial. BMJ. 2022 Feb 2;376: e067194.
- Grunebaum MF, Galfalvy HC, Choo TH, Parris MS, Burke AK, Suckow RF, et al. Ketamine metabolite pilot study in a suicidal depression trial. J Psychiatr Res. 2019 Oct 1;117: 129–34.
- Kaur S, Parmar C, Gaur V, Chauhan A, Andrade C. The efficacy of oral ketamine in severely depressed patients at high risk of suicide. Asian J Psychiatry. 2023 Aug 1; 86:103678.
- Singh B, Jennifer, Pazdernik VK, Frye MA, Kung S. Treatment-resistant depression patients with baseline suicidal ideation required more treatments to achieve therapeutic response with ketamine/esketamine. J Affect Disord. 2024 Apr 15; 351: 534–40.
- Hochschild A, Keilp JG, Madden SP, Burke AK, Mann JJ, Grunebaum MF. Ketamine vs midazolam: mood improvement reduces suicidal ideation in depression. J Affect Disord. 2022 Mar 1; 300:10–6.
- Zolghadriha A, Anjomshoaa A, Jamshidi MR, Taherkhani F. Rapid and sustained antidepressant effects of intravenous ketamine in treatment-resistant major depressive disorder and suicidal ideation: a randomized clinical trial. BMC Psychiatry. 2024 May 7;24(1):341-9.
- Leocovick L, Bubans AB, Bernardes L, Bohnen LC, Zancanaro M. Ketamina no manejo da dor aguda: uma revisão integrativa. BJIHS. 2023 Sep 13; 5(4): 1794–814.
- De Giorgi R. Ketamine for suicidal ideation. BMJ. 2022 Feb 2;376: e74.
- Jones GH, Vecera CM, Ruiz AC, Wu HE, McInturff SI, Orejarena MJ, et al. A randomized, double-blind, placebo-controlled pilot trial of the acute antisuicidal and antidepressant effects of intranasal (R,S)-ketamine in severe unipolar and bipolar depression with and without comorbid alcohol use disorder. J Clin Psychiatry. 2024 Apr 24;85(2): 1497-504.
- Lin WC, Chen MH, Su TP, Li CT, Wu HJ, Tsai SJ, et al. Effects of low-dose ketamine infusion on the positive and negative domains of hopelessness and suicidal thoughts. J Clin Psychiatry. 2024 Jul 8;85(3): 24m15257.
- Whitaker T, Farrand KF, Thase ME. A phase 2 open label study of efficacy, safety, and tolerability of SLS-002 (intranasal racemic ketamine) in adults with MDD at imminent risk of suicide. Psychopharmacol Bull. 2025 Mar 4;54(1): 8-17.
- Ahmadi J, Mansoori A, Seyed Hamdollah Mosavat, Bazrafshan A. Comparison of ketamine with buprenorphine as adjunctive therapy in the treatment of comorbid major depressive disorder and opium use disorders: a randomized controlled trial. Int J Psychiatry Med. 2023 Dec 23; 59(5): 521-35.
- Jha MK, Wilkinson ST, Krishnan K, Collins KA, Sanacora G, Murrough J, et al. Ketamine vs electroconvulsive therapy for treatment-resistant depression. JAMA Netw Open. 2024 Jun 25;7(6): e2417786.
- Jollant F, Dematteï C, Fabbro P, Abbar M. Clinical predictive factors and trajectories of suicidal remission over 6 weeks following intravenous ketamine for suicidal ideation. J Affect Disord. 2024 Feb 15; 347: 1-7.
- Ahmed GK, Elserogy YM, Elfadl GMA, Abdelsalam KG, Ali MA. Antidepressant and anti-suicidal effects of ketamine in treatment-resistant depression associated with psychiatric and personality comorbidities: a double-blind randomized trial. J Affect Disord. 2023 Mar 15; 325:127–34.
- Vanderschelden B, Gebara M, Ajam Oughli H, Butters MA, Brown PJ, Farber NB, et al. Change in patient-centered outcomes of psychological well-being, sleep, and suicidality following treatment with intravenous ketamine for late-life treatment-resistant depression. Int J Geriatr Psychiatry. 2023 Jul 1;38(7): e5964.
- Gilbert JR, Gerner JL, Burton CR, Nugent AC, Zarate CA, Ballard ED. Magnetoencephalography biomarkers of suicide attempt history and antidepressant response to ketamine in treatment-resistant major depression. J Affect Disord. 2022 Sep 1; 312:188–97.
- Gaither R, Ranney M, Peachey A, Burock J, Rogers J, Bucci L, et al. A feasibility study of low-dose ketamine for acute management of suicidal ideation. J Am Coll Emerg Physicians Open. 2022 Aug15; 3(4): e12790.
- Domany Y, McCullumsmith CB. Single, fixed-dose intranasal ketamine for alleviation of acute suicidal ideation: an emergency department, trans-diagnostic approach: a randomized, double-blind, placebo-controlled, proof-of-concept trial. Arch Suicide Res. 2022 Jul-Sep;26(3):1250-65.
- Keilp JG, Madden SP, Marver JE, Frawley A, Burke AK, Herzallah MM, et al. Effects of ketamine versus midazolam on neurocognition at 24 hours in depressed patients with suicidal ideation. J Clin Psychiatry. 2021 Nov 2;82(6): 21m13921.
- Feeney A, Hock RS, Freeman MP, Flynn M, Hoeppner B, Iosifescu DV, et al. The effect of single administration of intravenous ketamine augmentation on suicidal ideation in treatment-resistant unipolar depression: results from a randomized double-blind study. Eur Neuropsychopharmacol. 2021 Aug; 49:122–32.
- Beaudequin D, Can AT, Jones M, Yang C, Scherman JK, Dutton M, et al. Relationships between reduction in symptoms and restoration of function and wellbeing: outcomes of the Oral Ketamine Trial on suicidality (OKTOS). Psychiatry Res. 2021 Nov 1;305: 114212.
- Can AT, Hermens DF, Dutton M, Gallay CC, Jensen E, Jones M, et al. Low dose oral ketamine treatment in chronic suicidality: an open-label pilot study. Transl Psychiatry. 2021 Feb 4;11(1): 101 – 10.
- Gilbert JR, Ballard ED, Galiano CS, Nugent AC, Zarate CA. Magnetoencephalographic correlates of suicidal ideation in major depression. Biol Psychiatry Cogn Neurosci Neuroimaging. 2020 Mar;5(3): 354–63.
- Grunebaum MF, Galfalvy HC, Liu J, Huang Y, Marcott S, Burke AK, et al. Opioid receptor μ-1 and ketamine effects in a suicidal depression trial. J Clin Psychopharmacol. 2020 Jun 25;40(4):420–2.
- Vieira F, Correia-Melo FS, Santos-Lima C, Souza-Marques B, Leal GC, Jesus-Nunes AP, et al. Ketamine and esketamine augmentation for suicidal ideation: a randomized, double-blinded clinical trial. Gen Hosp Psychiatry. 2021 Jan 1; 68:97–9.
- Kheirabadi D, Kheirabadi GR, Mirlohi Z, Tarrahi MJ, Norbaksh A. Comparison of rapid antidepressant and antisuicidal effects of intramuscular ketamine, oral ketamine, and electroconvulsive therapy in patients with major depressive disorder. J Clin Psychopharmacol. 2020 Oct 16;40(6):588–93.
- Phillips JL, Norris S, Talbot J, Hatchard T, Ortiz A, Birmingham M, et al. Single and repeated ketamine infusions for reduction of suicidal ideation in treatment-resistant depression. Neuropsychopharmacology. 2020 Mar; 45(4): 606–12.
- Chen MH, Lin WC, Wu HJ, Cheng CM, Li CT, Hong CJ, et al. Antisuicidal effect, BDNF Val66Met polymorphism, and low-dose ketamine infusion: reanalysis of adjunctive ketamine study of Taiwanese patients with treatment-resistant depression (AKSTP-TRD). J Affect Disord. 2019 May 15; 251:162–9.
- Zhan Y, Zhang B, Zhou Y, Zheng W, Liu W, Wang C, et al. A preliminary study of anti-suicidal efficacy of repeated ketamine infusions in depression with suicidal ideation. J Affect Disord. 2019 May 15; 251:205–12.
- Domany Y, Shelton RC, McCullumsmith CB. Ketamine for acute suicidal ideation: an emergency department intervention: a randomized, double-blind, placebo-controlled, proof-of-concept trial. Depress Anxiety. 2019 Nov 16;37(3): 224–33.
- Zanos P, Moaddel R, Morris PJ, Riggs LM, Highland JN, Georgiou P, et al. Ketamine and ketamine metabolite pharmacology: insights into therapeutic mechanisms. Pharmacol Rev. 2018 Jul;70(3):621-60.
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Copyright (c) 2026 Mariana Alfena Ostwald, Marcos Antônio Mendonça, Ana Clara Pinheiro Andrade, Camila Trotta Lourenço de Lemos, Gustavo Alves Henderson Cardoso, João Victor Macedo de Oliveira, Juliana Silveira Sola, Luan Gabriel Affonso, Maria Victoria da Costa Farfan, Milla Daudt Ribeiro