SUICIDE PREVENTION – NEW TREATMENT

Suicide is the second leading cause of death in age groups 10 to 44, as per National Vital Statistics Reports Volume 68, number 24, 2019. Over 70% of people that commit suicide suffers from depression. Depression is now the leading cause of disability worldwide surpassing HIV/AIDS, Malaria, Diabetes and injuries from war.

Unfortunately, we can not treat suicide, but we can prevent and treat thoughts of suicide and the act itself. We can do so by treating severe Major Depression Disorder (MDD). Common antidepressants may take several weeks to take effect, and some might not actually work, sometimes leading to the use of another antidepressants delaying the response to treatment even more. Some patients may even become treatment resistant. When antidepressants fail, the most common recommended treatment is Electroconvulsive Therapy (ECT), which consist on passing an electrical current through the brain. This carries unwanted side effects such as skin burns, permanent memory loss, physical/dental trauma during the procedure, and cardiovascular complications like arrhythmias.

In 1962, a medication called KETAMINE was synthesized. A few years later it began it use in humans and, in 1970, it was FDA approved as an anesthetic suitable for children, adults and the elderly. It is a controlled medication due to it potential for abuse. In the 1990s, Ketamine then began its use as an adjunct to anti-depressant psychotherapies.

In 2009, Price, Charney, Knock, and Matthew showed a correlation between ketamine and the alleviation of depressive symptoms and reduction in suicidal thoughts. Studies have demostrated a rapid reduction in symptoms following a single dose of ketamine and prolonged results (weeks to months) with frequent repeated doses. A rapid antidepressant effect was noted in most studies presented, when Ketamine was used alone or in combination with other therapies. The results showed a 71-79% response rate 24 hours post ketamine infusion, while traditional antidepressants have a response rate of 65% seen after 6-8 weeks of treatment. There is a rapid anti-suicidal effect independent of antidepressant response ( Matthew, 2016). A significant reduction of suicidal ideation after one dose of ketamine was proven.

Ketamine administration to rats resulted in increased growth and function of dendritic synapses in the prefrontal cortex, usually at deficit in depressive disorders. This region of the brain is associated with planning, personality expression, decision making, and moderating social behavior. There was a dramatic increase in neuronal connectivity just hours after giving the rats Ketamine. Increased neuronal activity is thought to relieve depressive symptoms. Instead of waiting for new neurons to form (standard antidepressant medications), ketamine rapidly increases communication between existing neurons by creating new connections. (Hyde, 2015).

Functional MRI study in humans showed that prior to ketamine, patients had a reduced response to positive stimuli within the striatum (part of the reward circuit); 24 hours post treatment, they showed a rapid normalization in brain responses to positive stimuli within the striatum (part of the reward circuit); 24 hours post-treatment, they showed a rapid normalization in brain responses to positive stimuli (Matthew, 2016). Ryan in 2014 showed no evidence of serious neurocognitive adverse effects in clinical use.

Conclusions of these studies confirmed Ketamine is efficacious for a large percentage of patients with Treatment Resistant Depression (TRD). With its rapid onset, high efficacy, good tolerability, and high safety margin, ketamine is another tool in treating patients with depressive disorders.

It should be noted that ketamine is just one component of an overall treatment plan. It should not replace the patient's current regimen/medication, but it may reduce the dose of the medication decreasing unwanted side effects. Depression is best managed in combination with psychoterapy where people can get aid in changing netative thought patterns and behaviors.

More recent studies show beneficial effects in other psyquiatric disorders such us Obsessive-Compulsive Disorders (OCD), Post-Traumatic Stress Disorder (PTSD), anxiety, and alcohol/substance abuse. It could significantly lower morbidity and mortality for MDD and other psychiatric disorders. Ketamine may be a life-changing medication in the treatment of MDD, minimizing disruption to personal, family, occupational life and functioning, as well as lowering the risk of suicide.

Patients undergoing a Ketamine may experience an unusual floating sensation, dizziness, nausea, increase in heart rate and blood pressure during infusion and sensitivity to bright light and loud noise. All this side effects can be easily managed if the patient is on the hands of a skilled Board-Certified Physician Anesthesiologist. The diagnosis should preferably involve a Psychiatrist or Psychoterapist or Psychologist, but the treatment should be in the hands of a skilled Board-Certified Physician Anesthesiologist.

As a Pain Management physician, I use Ketamine infusion to treat patiens with severe pain and CRPS. Having the appropiate infrastructure and experience as an skilled Board Certified Anesthesiologist, to monitor and treat patients during Ketamine infusions, I feel morally obligated to use my experience with this medication to help patients with TRD an with suicidal ideation before or after a failed suicide attempt to rapidly reduce their symptoms while the antidepressant medication and therapy take full effect.

Ketamine is a general anesthetic that may reverse the loss of neuronal connections and brain atrophy reversing the symptoms of many Mood Disorders with minimal, if any, long term side affects. However, the administration of the infusion requires strict and close monitoring of the patient, as it's administration has several severe side effects that requires the presence of a Board Certified and experience Anesthesiologist immediately available. Michael Jackson had the experience of being treated with a medication that should be only handle by a Board Certified Anesthesiologist. 

The most common inconveniences for this treatment are the need of an IV insertion, the non-coverage (cost) by insurance companies, the time of treatment (about 2 to 3 hours) and the need of a companion that drives the patient back home the day of treatment. Another inconvenience is the need of several treatments at the begining and then the maintenance treatment every 4 to 6 weeks.

Together, let us try to lower those ugly statistics regarding suicide in our area and bring joy to patients and families of our neighborhoods.

If you, a friend, a family member or any person you know is battling, with PTSD, OCD, Major Depressive Disorder, Bipolar Disorder, alcohol/substance abuse, anxiety, intractable migraine, CRPS, or severe chronic pain call INFUSION THERAPY FOR LIFE at PALM BEACH PAIN (561) 248 1166. We prefer if you are referred directly from your Psychiatrist or Psychoterapist.

Author

Ricardo Leano, MD Ricardo Leano, MD, is a pain management and regenerative medicine specialist at Palm Beach Pain, LLC, in Palm Beach Gardens, Florida. Dr. Leano is committed to alleviating pain and maximizing the mobility and quality of life for his patients with the lightest touch of medicine, with the goal of avoiding all side effects in the process and making life as great as it should be. He values getting to know his patients and learning about their interests, goals, and concerns.