Celebrity Suicides Increase Suicide Risk in the General Population: The Promising & Rapid Antidepressant Effects of Ketamine Infusion Therapy

By Gaurav Dubey (M.S. Biotechnology)
Laboratory Technician: Rush Medical Center Dept. of Pediatric Cardiothoracic Surgery & Scientific Media Professional

 

Death of a loved one tends to send ripples across families and communities. In the case of suicide, ripples quickly turn to shockwaves of confusion and despair. The Center for Disketamine infusion therapy suicide celebrity suicide ease Control (CDC) published new data in June showing a 30% increase in suicides over the last 15 years, painting a grim reality of our current state of mental healthcare in America(1). These reports coincidentally came out on the heels of two tragic celebrity suicides: Anthony Bourdain and Kate Spade. Despite being one of the most developed nations in the world, adequate mental healthcare, education and access to effective treatment is clearly lacking. When the famous and wealthy people of the world can’t seem to find a way out of such severe mental illness, what kind of message does that send to the general population and how does it affect us? It may seem farfetched, but celebrity suicides do severely impact the general populous beyond grieving the loss of a beloved entertainer. In fact, the social and public health repercussions of celebrity suicide are very real and have been documented repeatedly(2,3,4).

Celebrity Suicide as a “Suicide Contagion”: Epidemiological Impact

When a national icon or well-known celebrity takes their own life, the psychosocial and epidemiological ramifications to public health can be tragic and profound. Indeed, it has been clinically documented multiple times that celebrity suicide and the associated media coverage surrounding it have a significant impact on suicide rates among the general population; in short: suicide rates temporarily increase following celebrity suicides(2,3,4). The number of suicides in the months immediately following the August 11th, 2014 suicide of beloved actor and comedian, Robin Williams, was statistically shown to be almost 10% greater than the expected average, as documented in a 2018 study published in February(2). While being “contagious” is not generally associated with the notion of mental illness, the term “suicide contagion” is beginning to be used in academic and medical literature to describe the phenomenon by which exposure to suicide and its portrayal in the media may increase the risk of suicide in the population(3).suicide anthony bourdain celebrity suicide

The Human Connection in the Digital Age: The Spread of Harmful Ideas

Suicide is already a major public health concern in itself, one that is clearly susceptible to external influence. What factors then can contribute to this susceptibility? The Internet has established a uniquely sophisticated, ethereal and global human connection in a way that was never before possible. Could this very connection essentially amplify the negative impact of celebrity suicide on public health so much so that those already entertaining the idea of suicide are more likely to go through with it? It’s almost as if such news acts as an infectious agent; a metaphysical or ideological pathogen that spreads through this very same connection and claims the lives of an already vulnerable population of people. This should be cause for alarm; highlighting the need for a better equipped arsenal when battling the debilitating, and all too often deadly diagnosis of depression and the pathophysiological factors that cause it.

The recent news of beloved “Parts Unknown” host and chef, Anthony Bourdain and popular entertainer, Kate Spade, have yet again forced us to ask the tough questions: “Are we really doing everything we can to treat and prevent this from happening again? Can we be doing more?”

Traditional Antidepressants Aren’t Workingtraditional antidepressants not working SSRI suicide ketamine

Dr. Feifel, professor of psychiatry at UC San Diego, openly admits to how ineffective modern day anti-depressants (e.g. SSRI’s like Zoloft and Prozac) are at treating major depression(5). The enormous amount of time that’s taken for the drug to be even potentially efficacious is on the order of weeks for most patients. Adding to that, the “tremendous” amount of patients with treatment-resistant depression only calls out louder for better, more effective alternatives(5). Despite millions of prescriptions over several years, traditional antidepressants (e.g. Zoloft, Prozac) have clearly failed to provide relief from debilitating depression characterized by suicidal ideation and behavior. The recent evaluation of suicide rates by the CDC showing the stark 30% rise across the U.S. tell us that much(1). Given the grave nature of severe clinical depression and the growing reality that suicide is happening a lot more frequently than we thought, clinicians and patients alike are turning to a curiously radical new form of treatment; one that works in hours instead of weeks or months and blows traditional approaches to treating suicide prone depression out of the water.

Ketamine Infusion Therapy: Equal Parts Radical, Rapid & Radically Effective

Traditional anti-depressant medication can take up to several weeks to start working with unimpressive efficacy(5). Desperate for answers, we as a healthcare community and society at large demanded more. Every celebrity death ruled a suicide brings with it the cold reminder that this illness is out there, claiming, as per the American Foundation for Suicide Prevention (AFSP), an average of 123 lives a day. Needless to say, we needed something better and we needed it yesterday. Much to the surprise of the clinical community, this “radical new treatment” actually utilizes a single drug that’s been used in hospitals and nightclubs around the world for decades(5,6). Ketamine Hydrochloride, an NMDA receptor antagonist that stimulates the neurotransmitter glutamate, is a commonly used anesthetic in hospitals that has also nestled its way into the rave scene for its out-of-body experiences (OBE) many users report(5,6). The growing expanse of research as it relates to the off-label use of Ketamine for depression, however, is catching the eye of patients and healthcare providers alike, all around the world.

A 2018 story published in the Chicago Tribune recalls the journey of Misra, a therapist and college instructor from Lisle who, after more than three decades of debilitating depression, began to actively plan her suicide. Fortunately, she is one of many who are now finding relief in this new treatment utilizing Ketamine for depression. “I went from actively wanting to kill myself to being fine,” Misra quotes to the Tribune. For millions of people around the world who have tried “everything” for their depression, there may finally be some hope.

Psychiatrist Dr. Abid Nazeer, an expert in the field, has successfully treated many patients with Ketamine infusion therapy in his Oakbrook clinic, Advanced Psychiatric Solutions. “It’s much better than anything we’ve had before,” states Dr. Nazeer in the aforementioned Tribune article. “I’ve seen it work so quickly that one infusion gets rid of suicidal thoughts that had been there for 20 years.” His clinic is now one of four in the Chicagoland area; as excitement about this therapy grows, so does demand. As of April 8th, 2018 (the publication date for the tribune article), Chicago already has 4 locations offering this innovative and groundbreaking treatment.

What is Ketamine Infusion Therapy?

Unlike the FDA approved use of Ketamine as an anesthetic, evidence shows sub-anesthetic doses of intravenously administered Ketamine is demonstrably providing rapid and lasting anti-depressant effects in suicidal and severely depressed patients(5,6). The current data revolving around psychiatric hospitalization for suicidal patients is dismal, with evidence indicating “suicide risk peaks in periods immediately after admission and discharge”(7). As such, Ketamine infusion therapy has even been recommended in cases of acute suicidality in hospital emergency rooms due to its rapid onset, wide safety margin and long-lasting antidepressant effects(5,6)

How Does Ketamine Infusion Therapy Work?

The exact process by which ketamine positively impacts severe clinical depression is not yet known. Unlike traditional antidepressants that act on serotonin, a neurotransmitter (chemical messenger in the brain) commonly associated with “feeling good”, ketamine uses a completely different mechanism of action by modulating glutamate (another neurotransmitter), perhaps inducing beneficial changes to gene expression and signaling cascades that are in effect long after the drug as worn off(5,6). Interestingly enough, it is hypothesized the increased glutamate release by ketamine therapy may in fact cause new connections to form in the brain via a factor called BDNF, which is a supposed mechanism for remodeling of the brain when using traditional antidepressants(6,7). What is known about ketamine therapy now is that severe depression, even in patients who have been suffering for years and exhausted all other treatment measures, have finally found lasting relief in as little as hours(5,6).

What Should I Expect?

Being a popular club drug, one can assume there are psychotropic effects of ketamine that, in putting it lightly, may be less than palatable for some patients. Hallucinations and OBE’s are commonly reported, however, the effects rapidly diminish within minutes after therapy cessation(5,6). As with any treatment, there are risks and benefits patients should clearly discuss with their healthcare provider. That said, after 50 successful years of clinical use, ketamine itself is highly touted as an incredibly safe compound with neuroprotective effects against toxicity, pain and inflammation(8). The abundance of promising data regarding sub-anesthetic doses of ketamine and depression were very likely made possible by the therapeutic index and safety profile of this drug. While single doses of ketamine have shown to have profound antidepressant effects alone, the medical literature recommends a series of 30-40 minute infusions performed by a qualified physician and their staff in a clinical setting(5,7,8,10). Even more intriguing is the fact that ketamine is so incredibly short acting (hence the need for a “drip” so the drug can be consistently administered at a low dose over the span of the infusion) that it is an outpatient procedure that is safe, simple and effective(5.6.7.8). It is for this reason that there is a strong argument to be made in using ketamine in ER settings when patients present with acute suicidal ideation and/or behavior and data shows that it is upon admission and discharge that probability for suicide is the highest(6,9). Patients and clinicians have observed best outcomes when repeated infusions are administered, instead of only one, when evaluating patient depression(5,7,8,9)

 

Is Ketamine Therapy Right For Me?

Despite the suicide prevention efforts of the last decade, there exists in the world today mental illness so powerful and deadly that it has significantly increased our nation’s suicide rate over the last 15 years(1). Improper mental healthcare and access to life saving treatments can potentially bear devastating psychosocial and epidemiological impacts on the public health–especially when we see those who are idolized by millions suffer the same pain and choose to take their own life, just as the estimated 100+ others worldwide on a daily basis(2,3,4). Clearly, it’s urgent that a more rapid and efficacious treatment be explored to mitigate this global epidemic. Study after study shows promise that ketamine infusion therapy could indeed be that answer we as a society have been looking. From commonplace anesthetic to popular club drug, this unique compound is beginning to show genuine, evidence-backed promise in the crisis treatment for severe depression and cases of acute suicidality(5,6,7,8). Whether one has been struggling for months, years or even decades, a myriad of studies from case reports to double-blind trials have demonstrated ketamine’s efficacy across the spectrum of demographics and pathologies(5,6,7,8,9).

Time for Things to Change: A Final Note on Ketamine & Suicide

Over the last two years, a number of sociopolitical and socioeconomic issues have risen up and found their way on to the national stage. However, one issue that can no longer remain in the shadows is that of mental health and suicide. The loss of someone who has touched the lives of millions, if not billions, to this affliction, is a constant reminder of the severity and gravity of this epidemic. While celebrities may be humans like the rest of us, it is without a doubt that their actions do indeed have a ripple effect, for better or for worse, across humanity(2,3,4). In fact, it is exactly that they too are human, that makes this issue so tragic and unbearable. The need for change in our perception and practice in the treatment of severe depression and suicide is long overdue.

Rarely do we witness in science/medicine, an effective treatment for a dangerous, deadly and increasingly prevalent disease that is simultaneously safe, fast-acting, efficacious and long-acting in a variety of patients (5,6,7,8). While further research is indeed a necessity, especially when considering long term, consistent use at these sub-anesthetic doses, ketamine infusion therapy most definitely seems to hold a promising place in the field of mental healthcare.

If you or someone you know is in crisis and needs immediate help, please reach out to the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255) to be connected to a trained counselor at a suicide crisis center nearest you.

 

About the Author: Gaurav Dubey is a passionate scientist and scientific media professional, particularly in the area of scientific blogging. He currently does clinical research on heart disease at Rush Medical Center in Chicago in the department of Pediatric Cardiothoracic Surgery. He is also on the board of directors for a new educational non-profit, Teach TEAM, which aims to provide free tutoring to underserved populations. He earned his Master’s in Biotechnology from Rush University and dual bachelor degrees in Biology and Philosophy from the University of Miami, FL. He hopes to continue pursuing his dream of artfully crafting scientific, evidence-based content for the world at large. 

 

 

 

 

 

 

 

Scholarly References

  1. Greenberg, R. (2018). Suicide deaths climb dramatically in U.S., nearly double for women.Psychiatrics News, 1176/appi.pn.2018.7a24 Retrieved from https://psychnews.psychiatryonline.org/doi/full/10.1176/appi.pn.2018.7a24
  2. Fink, D. S., Santaella-Tenorio, J., & Keyes, K. M. (2018). Increase in suicides the months after the death of robin williams in the US.PloS One, 13(2), e0191405. 10.1371/journal.pone.019140

  3. Qijin Cheng, Hong Li, Vincent Silenzio, & Eric D Caine. (2014). Suicide contagion: A systematic review of definitions and research utility.PLoS One, 9(9), e108724. 10.1371/journal.pone.0108724 Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/25259604

  4. Pirkis, J. and Nordentoft, M. (2011). Media Influences on Suicide and Attempted Suicide. In International Handbook of Suicide Prevention (eds R. C. O’Connor, S. Platt and J. Gordon). doi:1002/9781119998556.ch30

  5. Kirby, Tony. Ketamine for depression: the highs and lows (2015). The Lancet Psychiatry, Volume 2, Issue 9, 783 – 784

  6. Lee, J., Narang, P., Enja, M., & Lippmann, S. (2015). Use of ketamine in acute cases of suicidality.Neuroscience, 12(1-2), 29-31. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4382138/

  7. Björkholm, C., & Monteggia, L. M. (2016). BDNF – a key transducer of antidepressant effects. Neuropharmacology, 102, 72-79. 10.1016/j.neuropharm.2015.10.034 Retrieved from https://www.sciencedirect.com/science/article/pii/S002839081530157X

  8. Kurdi, M. S., Theerth, K. A., & Deva, R. S. (2014). Ketamine: Current applications in anesthesia, pain, and critical care. Anesthesia, Essays and Researches, 8(3), 283-290. 10.4103/0259-1162.143110 Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4258981/
  9. Qin, P., & Nordentoft, M. (2005). Suicide risk in relation to psychiatric hospitalization: Evidence based on longitudinal registers.Archives of General Psychiatry, 62(4), 427-432. 10.1001/archpsyc.62.4.427

  10. Wilkinson, S. T., Ballard, E. D., Bloch, M. H., Mathew, S. J., Murrough, J. W., Feder, A., . . . Sanacora, G. (2018). The effect of a single dose of intravenous ketamine on suicidal ideation: A systematic review and individual participant data meta-analysis.The American Journal of Psychiatry, 175(2), 150-158. 10.1176/appi.ajp.2017.17040472

 

 

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