title: A New Perspective on the Anti-Suicide Effects With Ketamine Treatment: A Procognitive Effect.
abstract: Available evidence indicates that a single, low-dose administration of ketamine is a robust, rapid-onset intervention capable of mitigating depressive symptoms in adults with treatment-resistant mood disorders. Additional evidence also suggests that ketamine may offer antisuicide effects. Herein, we propose that the antidepressant effects reported with ketamine administration are mediated, in part, by targeting neural circuits that subserve cognitive processing relevant to executive function and cognitive emotional processing. Empirical support for the conceptual framework of the cognitive domain as a critical target of ketamine's action is the additional observation that pretreatment cognitive function predicts treatment outcomes with ketamine administration. The proposal that beneficial effects on cognitive function may be, in some individuals, the proximate mechanism mitigating symptom relief in mood disorders exists alongside the well-established deleterious effect of ketamine on cognitive function. During the past 5 years, there have been several reviews and meta-analyses concluding that ketamine has possible clinical benefits in refractory mood disorders. We introduce the conceptual framework that ketamine's salutary effects, notably in suicidality, may in part be via procognitive mechanisms.
authors.affiliation: From the *Mood Disorders Psychopharmacology Unit, University Health Network; †Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; ‡Psychiatric Center Copenhagen, Department O, Copenhagen, Denmark; and Departments of §Psychiatry and ∥Pharmacology, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Yena
authors.initials: Y
authors.lastname: Lee
authors.forename: Kahlood
authors.initials: K
authors.lastname: Syeda
authors.forename: Nadia A
authors.initials: NA
authors.lastname: Maruschak
authors.forename: Danielle S
authors.initials: DS
authors.lastname: Cha
authors.forename: Rodrigo B
authors.initials: RB
authors.lastname: Mansur
authors.forename: Ida K
authors.initials: IK
authors.lastname: Wium-Andersen
authors.forename: Hanna O
authors.initials: HO
authors.lastname: Woldeyohannes
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Rosenblat
authors.forename: Roger S
authors.initials: RS
authors.lastname: McIntyre
mesh_terms: D000328:Adult; D003071:Cognition / Q000187:drug effects; D061218:Depressive Disorder, Treatment-Resistant / Q000188:drug therapy* / Q000523:psychology; D018691:Excitatory Amino Acid Antagonists / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D007649:Ketamine / Q000494:pharmacology / Q000627:therapeutic use*; D019964:Mood Disorders / Q000188:drug therapy / Q000523:psychology; D000092864:Suicide Prevention
chemical_list: D018691:Excitatory Amino Acid Antagonists; D007649:Ketamine