A single ketamine infusion followed by low-dose buprenorphine significantly reduced suicidal ideation in adults with major depressive disorder, according to a study presented at the American Psychiatric Association's annual meeting.
Study Design and Methods
The randomized, double-blind, placebo-controlled trial involved 50 patients with major depression and active suicidal behavior. All participants received one IV infusion of ketamine; two days later, they were randomized to receive either an ultra-low dose of buprenorphine or placebo for four weeks. Assessments were conducted weekly.
Key Findings
Both groups experienced reductions in depressive symptoms, with no statistically significant difference between them. However, the combination group showed sustained reductions in suicidal thoughts compared to placebo.
After treatment ended, some rebound in depressive symptoms and suicidal thoughts was observed, though patients remained improved from baseline. No withdrawal symptoms were noted.
Authors' Perspective
Authors Alan F. Schatzberg and Jason M. Tucciarone from Stanford University said the findings offer a scalable and safe therapeutic option for suicide risk.
Outside Experts Urge Caution
Outside experts urged caution. Bertha Madras of Harvard Medical School noted that short-term benefits may not reflect long-term adverse effects.
Carl Hart of Columbia University said the study showed improvement in suicidal thoughts but not in depressive symptoms, and that endpoints were based on questionnaires, not real-world outcomes. He called for further study in patients actively contemplating suicide.