Ketamine/esketamine in the treatment of depression with comorbid borderline personality disorder or traits: A systematic review of effectiveness
Emma Scott, Don Thomas Thekkuden, Katelyn Kerr, Carla Meurk
Australian & New Zealand Journal of Psychiatry September 20, 2025 DOI: 10.1177/00048674251374472 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Systematic review Randomized Peer reviewed |
|---|---|
| Population | People with comorbid borderline personality disorder and depression |
| Interventions | ketamine esketamine |
| Topics | Depression Esketamine Ketamine |
| Keywords | Borderline personality disorder Suicidal ideation Depression economics Randomized controlled trial Systematic review Comorbidity Dissociative Clinical psychology Medline Poison control Clinical trial |
| Citations | 2 |
| Key findings | Ketamine or esketamine may improve depression symptoms in those with comorbid borderline personality disorder, but caution is warranted due to risks of suicidal ideation, self-harm, and acute dissociation. |
Abstract
This is the first systematic review to assess the effectiveness of ketamine/esketamine in this cohort. Our findings suggest that ketamine/esketamine may be useful in improving symptoms of depression, in those with comorbid borderline personality disorder. Limited study data are available; however, given case reports of suicidal ideation and self-harm following treatment cessation, as well as indications of a higher risk of acute dissociation in individuals with borderline personality disorder, clinicians should exercise caution when using ketamine to treat depression in this population. More data are required including a larger randomised control trial to assess the efficacy and side effects of ketamine/esketamine in this study population. Clinicians should, where available and appropriate, consider offering ketamine/esketamine to patients in this cohort.
Comparable studies
Other systematic reviews and meta-analyses on esketamine for depression, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Comparative efficacy of racemic ketamine and esketamine for depression: a systematic review and meta-analysis Adults with unipolar or bipolar major depression | 2020 | Systematic review and meta-analysis | n = 1,877 |
| The acute antisuicidal effects of single-dose intravenous ketamine and intranasal esketamine in individuals with major depression and bipolar disorders: A systematic review and meta-analysis. Participants in randomized controlled trials of ketamine for suicidal ideation | 2020 | Systematic review and meta-analysis | n = 197 |
| Efficacy of Esketamine Augmentation in Major Depressive Disorder Patients with major depressive disorder who are treatment-resistant or acutely suicidal | 2020 | Systematic review and meta-analysis | n = 774 |
| Esketamine Treatment for Depression in Adults: A PRISMA Systematic Review and Meta-Analysis. Patients with treatment-resistant major depressive disorder | 2025 | Systematic review and meta-analysis | |
| EFFICACY AND SAFETY OF RACEMIC KETAMINE AND ESKETAMINE FOR DEPRESSION: A SYSTEMATIC REVIEW AND META-ANALYSIS Adults with unipolar or bipolar major depression | 2022 | Systematic review and meta-analysis | n = 2,903 |
Citations in the library
Cites 12
- Side-effects associated with ketamine use in depression: a systematic review. The Lancet Psychiatry 2018
- Ketamine for rapid reduction of suicidal thoughts in major depression: a midazolam-controlled randomized clinical trial American Journal of Psychiatry December 5, 2017
- Ketamine for rapid reduction of suicidal ideation: a randomized controlled trial Psychological Medicine August 12, 2015
- Ketamine versus ECT for Nonpsychotic Treatment-Resistant Major Depression. New England Journal of Medicine May 24, 2023
- Ketamine for the treatment of major depression: a systematic review and meta-analysis EClinicalMedicine August 1, 2023
and 7 more in the library