その他令和7年2月26日
The Impact of the COVID-19 Pandemic on the Mental Health of Healthcare Workers
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令和7年2月26日
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政府調達
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政府調達p.46
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The Impact of the COVID-19 Pandemic on the Mental Health of Healthcare Workers
令和7年2月26日|p.46
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The Effect of a Single Dose of Intravenous Ketamine on Suicidal Ideation: A Systematic Review and Individual Participant Data Meta-Analysis
Samuel T. Wilkinson ${}^{1,*}$, Elizabeth D. Ballard ${}^{2}$, Mark H. Bloch ${}^{1}$, James R. Mathew ${}^{3}$,
John W. Murrough ${}^{4}$, Alexander Feder ${}^{4}$, Panagiotis Fasula ${}^{4}$, David Luckenbaugh ${}^{2}$,
Gerard Sanacora ${}^{1}$, Carlos A. Zarate Jr. ${}^{2}$ and Benjamin N. Cukor ${}^{1}$
${}^{1}$ Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06519, USA;
mark.bloch@yale.edu (M.H.B.); gerard.sanacora@yale.edu (G.S.); benjamin.cukor@yale.edu (B.N.C.)
${}^{2}$ Experimental Therapeutics & Pathophysiology Branch, National Institute of Mental Health,
National Institutes of Health, Bethesda, MD 20892, USA; elizabeth.ballard@nih.gov (E.D.B.);
david.luckenbaugh@nih.gov (D.L.); zarateca@mail.nih.gov (C.A.Z.Jr.)
${}^{3}$ Department of Anesthesiology, Yale University School of Medicine, New Haven, CT 06519, USA;
james.mathew@yale.edu
${}^{4}$ Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA;
john.murrough@mssm.edu (J.W.M.); alexander.feder@mssm.edu (A.F.);
panagiotis.fasula@mssm.edu (P.F.)
* Correspondence: samuel.wilkinson@yale.edu; Tel.: +1-203-737-2566
Received: 20 November 2017; Accepted: 10 January 2018; Published: 15 January 2018
Abstract:
Suicide is a public health crisis with limited treatment options. While intravenous ketamine has been shown to have antidepressant effects, whether ketamine also exerts acute anti-suicidal effects remains an important question. We performed a systematic review and individual participant data meta-analysis to assess the effects of ketamine on suicidal ideation. The systematic review was registered with PROSPERO (CRD42016047419). PubMed, PsycINFO, Embase, and Google Scholar were searched from inception through September 2017. Randomized controlled trials that compared single-dose intravenous ketamine to placebo or midazolam in participants with depression or bipolar disorder were included. Individual participant data were obtained from all six eligible trials ($n=167$). Mixed-effects models assessed the impact of ketamine on suicidal ideation at baseline, 230 min, and days 1, 2, 3, 7, and 14 post-infusion. Compared to control, ketamine rapidly reduced suicidal ideation, significantly at 6 h and days 1 and 3. Effects were maintained when controlling for depression severity. However, there was no significant difference between groups at day 7. Ketamine’s effect on suicidal ideation was not mediated by depression severity. These results suggest that ketamine may reduce suicidal thoughts in the short term; however, further studies are needed to determine whether these effects are unique to ketamine and if they translate into a reduction in suicide attempts.
Keywords: suicide; ketamine; depression; meta-analysis
1. Introduction
Suicide is a major public health problem, accounting for nearly one million deaths worldwide each year [1]. In the United States alone, over 44,000 people died by suicide in 2015, making it the tenth leading cause of death overall [2]. Despite its prevalence, there are few treatments available for individuals experiencing suicidal ideation. Current pharmacological interventions for suicidality include lithium and clozapine, both of which have demonstrated efficacy in reducing suicide risk in specific populations [3,4]. However, these medications require weeks to months to achieve therapeutic levels, limiting their utility in acute settings where rapid intervention is critical. Additionally, many patients do not respond adequately to existing treatments, highlighting the need for novel approaches targeting suicidal behavior directly.
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