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.
Comparable studies
Other narrative reviews on esketamine for depression, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Synthesizing the Evidence for Ketamine and Esketamine in Treatment-Resistant Depression: An International Expert Opinion on the Available Evidence and Implementation Adults with treatment-resistant depression | 2021 | Review | |
| Long-term safety of ketamine and esketamine in treatment of depression | 2022 | Review | |
| Ketamine, Esketamine, and Arketamine: Their Mechanisms of Action and Applications in the Treatment of Depression and Alleviation of Depressive Symptoms. | 2024 | Review | |
| Variations in BDNF and Their Role in the Neurotrophic Antidepressant Mechanisms of Ketamine and Esketamine: A Review. Patients with depression | 2024 | Narrative review | |
| The Possible Application of Ketamine in the Treatment of Depression in Alzheimer’s Disease | 2022 | Review |
Citations in the library
Cites 44
- Synthesizing the Evidence for Ketamine and Esketamine in Treatment-Resistant Depression: An International Expert Opinion on the Available Evidence and Implementation American Journal of Psychiatry March 17, 2021
- Efficacy and Safety of Intranasal Esketamine for the Rapid Reduction of Symptoms of Depression and Suicidality in Patients at Imminent Risk for Suicide: Results of a Double-Blind, Randomized, Placebo-Controlled Study American Journal of Psychiatry April 16, 2018
- Side-effects associated with ketamine use in depression: a systematic review. The Lancet Psychiatry 2018
- A Double-Blind, Randomized, Placebo-Controlled, Dose-Frequency Study of Intravenous Ketamine in Patients With Treatment-Resistant Depression American Journal of Psychiatry April 8, 2016
- Intravenous Esketamine in Adult Treatment-Resistant Depression: A Double-Blind, Double-Randomization, Placebo-Controlled Study Biological Psychiatry November 4, 2015
and 39 more in the library