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Humanist, humorist

Thursday, January 03, 2013

Suicide Prevention and Ketamine - Larkin & Beautrais

Ketamine and suicide prevention
Annette Beautrais and Gregory Larkin
Image courtesy of

Just when you thought it was safe to walk into the emergency department of a hospital for respite or treatment to an injury comes the latest study in suicide prevention and depression. A study so flawed and bizarre and, dare I say it, misleading.

The study was carried out by Gregory Larkin and Annette Beautrais, the conclusion of which found that the intervention of administering the horse tranquilizer, Ketamine, to patients suffering from depression or displaying suicidal tendencies is "likely to be effective and appropriate for only some subgroups of the depressed and suicidal emergency department population."

The study, carried out on 15 patients, ran over a period of just 10 days and saw patients given a single dose of Ketamine [dose depending on weight] and then monitored over a period of four hours whereby they were given a set of questions using the Montgomery–Åsberg Depression Rating Scale [MADRS]. These ratings  were obtained at baseline, and at 40, 80, 120 and 240 minute intervals. Patients were then contacted over a period of 10 days

There was no control group in this study, funded by Connecticut College of Emergency Physicians.

In essence it appears that the study only lasted 4 hours and the follow-up [10 days] was presumably to follow-up on the 15 patients to see how they were coping [ie; side effects, if depression or suicidal thoughts had returned]

This, it has to be said, is one of the most bizarre studies I've ever seen when time and outcome are taken into account... not to mention the drug used.

First off, Ketamine produces a dissociative state, characterised by a sense of detachment from one's physical body and the external world which is known as depersonalization and derealization. [1] One could argue that it produces the exact same feeling of someone who feels suicidal, in other words it's like treating a patient who has a migraine with a blow to the head with a mallet.

Ketamine is, in general, used as a general anaesthetic in both humans and animals, it's also used as a recreational drug.

Talk to Frank is a British website that helps people understand the effects of recreational drugs. For Ketamine they write:

  • It can make people feel very chilled out and relaxed, giving a feeling of floating away, as if mind and body have been separated.
  • It can make you physically incapable of moving. You can feel completely detached from your body and surroundings, which has been compared to having a near-death experience, sometimes called “entering the k-hole”.
  • When taken regularly or in large doses it can make existing mental health problems worse and cause confusion, panic attacks and depression. 

Seems to me that the last thing you would want to give to a person who feels suicidal would be a drug that makes you feel that your mind and body have been separated, makes you completely detached from your body and surroundings which makes you feel like you're having a near death experience.

When taken regularly Ketamine can make existing mental health problems worse and can actually cause depression.

Okay, I understand the study was just for short-term use but Holy Mother of God are we expected to believe that a drug that can cause all of the above is a solution to halt depression and suicidal thinking?

Well, Gregory Larkin, one of the study authors, seems to think so.

In email correspondence I asked him and Beautrais if they still stood by their findings. His somewhat thrifty response was also on behalf of co-author, Annette Beautrais:

Dear Mr Fiddaman
We [my italics] stand by our findings.  Not clear why you are even asking.
What is the basis of your query?

More worrisome, for me at least, is the conclusion... or how both authors arrived at the conclusion of their study given that no comparisons or even placebos were used.

In fact, their "comparison" appears to be based upon the fact that the 15 subjects did not have a significantly longer emergency department stay than 15, age and diagnosis-matched control subjects, who did not receive the drug.

So, you still feeling depressed or suicidal?

It left me thinking, because thoughts are all I have when authors refuse to comment, that the patients could have been petrified to say they still felt depressed or suicidal because the administered drug made them feel detached or having a near death experience. It makes me feel as if the inducement of Ketamine was a punishment rather than a treatment.

As a kid doing something wrong is normally met with repercussions. I envisage a child stealing an apple from their next door neighbour. The child's father learns and, rightly or wrongly, smacks his child and sends them to their room  Every 40 minutes or so an angry father walks in to his child's bedroom with the question, "Steal an apple again, would you?" The child, still feeling the burning sensation on his buttocks from the smacking, will, more than likely, answer, "No, dad.".


Well, because the child is merely appeasing his/her oppressor. Could the same not be said of the subjects in the Larkin/Beautrais study?

It's a fair enough question, isn't it? In fact the reluctance of the subjects to not feel suicidal could be down the a number of factors and not just the Ketamine. However, with no comparisons the authors are led to believe that it must be the Ketamine that has miraculously, albeit temporarily, cured depression and suicidal thinking. What else could it possibly be?

I've been meaning to blog about Beautrais for some time now, one thing or another has left her on the back-burner, all that, however, is about to change and over the coming weeks I'll be highlighting other studies [with no control groups] she has been involved in and her stance on suicide prevention and the use of psychiatric medication.

For now I just wish to throw this study out there for readers of this blog. To me it raises far more questions than answers and suggests that any Tom, Dick or Harry could apply for funding on the basis that design and methodology are irrelevant.

It's like treating obesity by force-feeding patients buckets of lard.

"Eat 4 burgers again would you, greedy guts?"

Strangely, the findings of the study were reported on the Medscape website back in 2010 where it lists Robert Turelli, MD as a co-author. There is no mention of either Larkin or Beautrais. The report also mentions 15 subjects whereas the study, available elsewhere on the internet only mentions 14 subjects. [2]

Both Beautrais and Larkin, according The University of Auckland Alumni Magazine, believe that openly talking about suicide is "pessimistic, fatalistic, and wrong".

I'm guessing they won't like the following video then:

[1] Giannini AJ, Underwood NA, Condon M (November 2000). "Acute ketamine intoxication treated by haloperidol  a preliminary study". American Journal of Therapeutics 7 (6): 389–91

[2] A preliminary naturalistic study of low-dose ketamine for depression and suicide ideation in the emergency departmentG. L. Larkin, A. L. Beautrais, R. R. Turelli, G. Sanacora, S. Powsner, M. Lippmann, J. Krystal -

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