| アブストラクト | Background: Ketamine and esketamine have been reported to rapidly alleviate various parameters of suicidality, with antisuicidal effects that may be independent of their rapid-acting antidepressant effects. However, it remains unclear whether ketamine and/or esketamine are associated with the emergence or worsening of suicidality. Methods: In this global observational pharmacovigilance cohort study, we analyzed suicidality reports associated with ketamine and esketamine using data from the World Health Organization's VigiBase, accessed from its inception through January 2024. Disproportionality was assessed using the reporting odds ratio (ROR), with significance defined as P < .05. Results: Compared to lithium, esketamine exhibited higher disproportionality for suicidal ideation (ROR = 5.13, 95% CI, 4.48-5.87, P < .0001), while ketamine showed lower disproportionality for suicidal ideation (ROR = 0.76, 95% CI, 0.58-0.99, P = .043), suicide attempt (ROR =0.17, 95% CI, 0.12-0.24, P < .0001), and completed suicide (ROR =0.30, 95% CI, 0.22-0.40, P < .0001). Esketamine also had lower RORs for suicide attempt (ROR = 0.46, 95% CI, 0.39-0.54, P < .0001) and completed suicide (ROR =0.36, 95% CI, 0.30-0.43, P < .0001). When fluoxetine was used as the reference, esketamine showed higher disproportionality for suicidal ideation (ROR = 3.34, 95% CI, 3.06-3.65, P < .0001), while ketamine had a lower ROR (ROR =0.49, 95% CI, 0.39-0.63, P < .0001). For suicidal behavior, esketamine had a lower ROR (ROR =0.37, 95% CI, 0.17-0.81, P = .012), and both ketamine (ROR =0.15, 95% CI, 0.10-0.21, P < .0001) and esketamine (ROR = 0.39, 95% CI, 0.34-0.45, P < .0001) had lower RORs for suicide attempt. Both agents also had lower RORs for completed suicides (ketamine: ROR = 0.24, 95% CI, 0.18-0.32, P < .0001; esketamine: ROR= 0.29, 95% CI, 0.25-0.35, P < .0001). Conclusion: Both increased and decreased RORs for suicidality parameters were observed with ketamine and esketamine, with similar results regardless of whether lithium or fluoxetine was used as the reference. However, causality between ketamine/esketamine use and changes in suicidality cannot be determined. |
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| ジャーナル名 | The Journal of clinical psychiatry |
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| Pubmed追加日 | 2025/7/10 |
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| 投稿者 | Kwan, Angela T H; Lakhani, Moiz; Rosenblat, Joshua D; Mansur, Rodrigo B; Rhee, Taeho Greg; Teopiz, Kayla M; Cao, Bing; Ho, Roger; Wong, Sabrina; Le, Gia Han; McIntyre, Roger S |
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| 組織名 | Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.;Brain and Cognition Discovery Foundation, Toronto, Ontario, Canada.;Department of Pharmacology and Toxicology, University of Toronto, Toronto,;Ontario, Canada.;Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut.;Department of Public Health Sciences, Farmington, Connecticut.;Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.;Key Laboratory of Cognition and Personality, Faculty of Psychology, Ministry of;Education, Southwest University, Chongqing, P. R. China.;Department of Psychological Medicine, Yong Loo Lin School of Medicine, National;University of Singapore, Singapore.;Institute for Health Innovation and Technology (iHealthtech), National University;of Singapore, Singapore.;Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.;Corresponding Author: Roger S. McIntyre, MD, Departments of Psychiatry &;Pharmacology and Toxicology, University of Toronto, 250 College St, 8th Floor,;Toronto, ON M5T 1R8, Canada (roger.mcintyre@bcdf.org). Drs Kwan and Lakhani share;co-first authorship. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/40637548/ |
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