Ketamine triggers morning cortisol surge tied to fewer suicidal thoughts—but the link remains uncertain
In 1970, ketamine was approved as an anesthetic. It works by blocking receptors in the brain. Suicidal tendencies are among the dangers that accompany severe depression. Doctors have found that a low dose of ketamine, much lower than what is used for anesthesia, can quickly ease depression and suicidal thoughts. It often works within hours to a day, much faster than conventional antidepressants.
A recent study published in the Journal of Affective Disorders reveals a potential link between ketamine treatment and an increase in morning cortisol levels among individuals with severe depression and suicidal thoughts. The research, conducted by a team from the New York State Psychiatric Institute and Columbia University, aimed to uncover the mechanism behind ketamine's rapid antisuicidal effects.
The investigators observed that 24 hours after administering a low dose of ketamine, patients experienced a notable surge in their morning cortisol levels, as measured through saliva samples. This increase was more pronounced in individuals who reported greater reductions in suicidal thoughts. However, while the connection between cortisol rise and decreased suicidal ideation appeared strong, it fell short of statistical significance.
Importantly, the study found that this cortisol elevation was unrelated to the patients' overall depression severity. Depression affects approximately 5.7% of adults worldwide, leading to over 450 million people suffering from the condition. Suicide rates are alarming, with over 727,000 deaths by suicide in 2021 alone. Ketamine's ability to alleviate severe depression symptoms within hours, as opposed to the weeks required for traditional antidepressants, has drawn the attention of researchers seeking to understand the drug's workings in the brain.
The hypothalamic-pituitary-adrenal (HPA) axis, responsible for regulating cortisol release and promoting morning alertness, is often impaired in individuals with depression and suicidal thoughts. This study suggests that the temporary rise in cortisol triggered by ketamine may help reset the brain's stress-response system, providing a biological buffer that enables patients to better manage emotional distress.
However, further research is needed to determine whether this cortisol increase directly contributes to ketamine's antisuicidal effects.
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