Angela T H Kwan, Moiz Lakhani, Joshua D Rosenblat, Rodrigo B Mansur, Taeho Greg Rhee, Kayla M Teopiz, Bing Cao, Roger Ho, Sabrina Wong, Gia Han Le, Roger S McIntyre
{"title":"一项基于全球人群的氯胺酮和艾氯胺酮与自杀之间关系的研究。","authors":"Angela T H Kwan, Moiz Lakhani, Joshua D Rosenblat, Rodrigo B Mansur, Taeho Greg Rhee, Kayla M Teopiz, Bing Cao, Roger Ho, Sabrina Wong, Gia Han Le, Roger S McIntyre","doi":"10.4088/JCP.24m15534","DOIUrl":null,"url":null,"abstract":"<p><p><b>Background:</b> 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.</p><p><p><b>Methods:</b> 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 <i>P</i> < .05.</p><p><p><b>Results:</b> Compared to lithium, esketamine exhibited higher disproportionality for suicidal ideation (ROR = 5.13, 95% CI, 4.48-5.87, <i>P</i> < .0001), while ketamine showed lower disproportionality for suicidal ideation (ROR = 0.76, 95% CI, 0.58-0.99, <i>P</i> = .043), suicide attempt (ROR =0.17, 95% CI, 0.12-0.24, <i>P</i> < .0001), and completed suicide (ROR =0.30, 95% CI, 0.22-0.40, <i>P</i> < .0001). Esketamine also had lower RORs for suicide attempt (ROR = 0.46, 95% CI, 0.39-0.54, <i>P</i> < .0001) and completed suicide (ROR =0.36, 95% CI, 0.30-0.43, <i>P</i> < .0001). When fluoxetine was used as the reference, esketamine showed higher disproportionality for suicidal ideation (ROR = 3.34, 95% CI, 3.06-3.65, <i>P</i> < .0001), while ketamine had a lower ROR (ROR =0.49, 95% CI, 0.39-0.63, <i>P</i> < .0001). For suicidal behavior, esketamine had a lower ROR (ROR =0.37, 95% CI, 0.17-0.81, <i>P</i> = .012), and both ketamine (ROR =0.15, 95% CI, 0.10-0.21, <i>P</i> < .0001) and esketamine (ROR = 0.39, 95% CI, 0.34-0.45, <i>P</i> < .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, <i>P</i> < .0001; esketamine: ROR= 0.29, 95% CI, 0.25-0.35, <i>P</i> < .0001).</p><p><p><b>Conclusion:</b> 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.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 3","pages":""},"PeriodicalIF":4.6000,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"A Global Population-Based Study on the Association Between Ketamine and Esketamine With Suicidality Using WHO VigiBase.\",\"authors\":\"Angela T H Kwan, Moiz Lakhani, Joshua D Rosenblat, Rodrigo B Mansur, Taeho Greg Rhee, Kayla M Teopiz, Bing Cao, Roger Ho, Sabrina Wong, Gia Han Le, Roger S McIntyre\",\"doi\":\"10.4088/JCP.24m15534\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p><b>Background:</b> 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.</p><p><p><b>Methods:</b> 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 <i>P</i> < .05.</p><p><p><b>Results:</b> Compared to lithium, esketamine exhibited higher disproportionality for suicidal ideation (ROR = 5.13, 95% CI, 4.48-5.87, <i>P</i> < .0001), while ketamine showed lower disproportionality for suicidal ideation (ROR = 0.76, 95% CI, 0.58-0.99, <i>P</i> = .043), suicide attempt (ROR =0.17, 95% CI, 0.12-0.24, <i>P</i> < .0001), and completed suicide (ROR =0.30, 95% CI, 0.22-0.40, <i>P</i> < .0001). Esketamine also had lower RORs for suicide attempt (ROR = 0.46, 95% CI, 0.39-0.54, <i>P</i> < .0001) and completed suicide (ROR =0.36, 95% CI, 0.30-0.43, <i>P</i> < .0001). When fluoxetine was used as the reference, esketamine showed higher disproportionality for suicidal ideation (ROR = 3.34, 95% CI, 3.06-3.65, <i>P</i> < .0001), while ketamine had a lower ROR (ROR =0.49, 95% CI, 0.39-0.63, <i>P</i> < .0001). For suicidal behavior, esketamine had a lower ROR (ROR =0.37, 95% CI, 0.17-0.81, <i>P</i> = .012), and both ketamine (ROR =0.15, 95% CI, 0.10-0.21, <i>P</i> < .0001) and esketamine (ROR = 0.39, 95% CI, 0.34-0.45, <i>P</i> < .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, <i>P</i> < .0001; esketamine: ROR= 0.29, 95% CI, 0.25-0.35, <i>P</i> < .0001).</p><p><p><b>Conclusion:</b> 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.</p>\",\"PeriodicalId\":50234,\"journal\":{\"name\":\"Journal of Clinical Psychiatry\",\"volume\":\"86 3\",\"pages\":\"\"},\"PeriodicalIF\":4.6000,\"publicationDate\":\"2025-07-07\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Clinical Psychiatry\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.4088/JCP.24m15534\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"PSYCHIATRY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Clinical Psychiatry","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.4088/JCP.24m15534","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PSYCHIATRY","Score":null,"Total":0}
引用次数: 0
摘要
背景：据报道氯胺酮和艾氯胺酮能迅速缓解各种自杀参数，并具有独立于其速效抗抑郁作用的抗自杀作用。然而，目前尚不清楚氯胺酮和/或艾氯胺酮是否与自杀倾向的出现或恶化有关。方法：在这项全球观察性药物警戒队列研究中，我们分析了与氯胺酮和艾氯胺酮相关的自杀报告，使用的数据来自世界卫生组织的VigiBase，从其成立到2024年1月。使用报告优势比（ROR）评估歧化程度，显著性定义为P < 0.05。结果：与锂离子相比，艾氯胺酮对自杀意念的歧化率较高（ROR = 5.13, 95% CI, 4.48 ~ 5.87, P < 0.0001），而氯胺酮对自杀意念（ROR = 0.76, 95% CI, 0.58 ~ 0.99, P = 0.043）、自杀企图（ROR =0.17, 95% CI, 0.12 ~ 0.24, P < 0.0001）、自杀未遂（ROR =0.30, 95% CI, 0.22 ~ 0.40, P < 0.0001）的歧化率较低。艾氯胺酮在自杀未遂（ROR = 0.46, 95% CI, 0.39-0.54, P < 0.0001）和自杀完成（ROR =0.36, 95% CI, 0.30-0.43, P < 0.0001）方面也有较低的ROR。以氟西汀为对照时，艾氯胺酮对自杀意念的歧化率较高（ROR = 3.34, 95% CI, 3.06-3.65, P < 0.0001），而氯胺酮的歧化率较低（ROR =0.49, 95% CI, 0.39-0.63, P < 0.0001）。对于自杀行为，艾氯胺酮具有较低的ROR (ROR =0.37, 95% CI, 0.17-0.81, P = 0.012)，并且氯胺酮（ROR =0.15, 95% CI, 0.10-0.21, P < 0.0001）和艾氯胺酮（ROR = 0.39, 95% CI, 0.34-0.45, P < 0.0001）在自杀企图方面具有较低的ROR。两种药物对于自杀成功率的ROR也较低(氯胺酮：ROR = 0.24, 95% CI, 0.18-0.32, P < 0.0001；艾氯胺酮：ROR= 0.29, 95% CI, 0.25-0.35, P < 0.0001)。结论：氯胺酮与艾氯胺酮对自杀参数的RORs均有升高和降低的作用，且与锂盐或氟西汀作为参比的结果相似。然而，氯胺酮/艾氯胺酮的使用与自杀倾向的改变之间的因果关系尚不能确定。
A Global Population-Based Study on the Association Between Ketamine and Esketamine With Suicidality Using WHO VigiBase.
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.
期刊介绍：
For over 75 years, The Journal of Clinical Psychiatry has been a leading source of peer-reviewed articles offering the latest information on mental health topics to psychiatrists and other medical professionals.The Journal of Clinical Psychiatry is the leading psychiatric resource for clinical information and covers disorders including depression, bipolar disorder, schizophrenia, anxiety, addiction, posttraumatic stress disorder, and attention-deficit/hyperactivity disorder while exploring the newest advances in diagnosis and treatment.
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