The use of repetitive transcranial magnetic stimulation (rTMS), electroconvulsive therapy (ECT), ketamine, and esketamine in reducing suicidality in major depressive disorder: A comprehensive narrative review
Trisha Menon, Andy Lu, Akhilan Arulmozhi, Christine E. Dri, Sabrina Wong, Kayla M Teopiz, Gia Han Le, Serene Lee, Cory R. Weissman, Roger S McIntyre
Psychiatry Research February 19, 2026 DOI: 10.1016/j.psychres.2026.117036 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Narrative review Randomized Peer reviewed |
|---|---|
| Population | Persons with major depressive disorder |
| Interventions | Ketamine Esketamine rTMS ECT |
| Topics | Depression Ketamine Esketamine |
| Keywords | Narrative review Transcranial magnetic stimulation Psychological intervention Randomized controlled trial Depression economics Clinical psychology Major depressive episode Psychotherapist Clinical trial Brain stimulation Depressive symptoms Electroconvulsive therapy studies |
| Key findings | Ketamine, esketamine, rTMS, and ECT are associated with reductions in suicidal ideation in people with major depressive disorder, with the strongest evidence supporting rapid, short-term effects for ketamine and esketamine. |
Abstract
Ketamine, esketamine, rTMS and ECT are associated with reductions in SI in persons with MDD, with the strongest evidence from randomized controlled trials supporting rapid, short-term effects, particularly for ketamine and esketamine. Further characterization and differentiation of the durability of antisuicidal effects of the aforementioned interventions requires investigation in large-scale, adequately-controlled clinical trials. In addition, whether reductions in SI following administration of these agents reduces the severity of aspects of suicidal behavior should be evaluated.