Single fixed-dose intranasal racemic ketamine treatment for the treatment of acute suicidality in a transdiagnostic patient population: Results of a pilot study.
Gijsbrecht H. J. Roelandt, Jurriaan F M Strous, Radboud M Marijnissen, Jeanine Kamphuis, Jens H van Dalfsen, Robert A Schoevers
Psychiatry Research March 1, 2026 DOI: 10.1016/j.psychres.2025.116909 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Pilot study Randomized Placebo-controlled Double-blind Open-label Peer reviewed |
|---|---|
| Sample size | 12 |
| Population | Acutely suicidal patients in an emergency setting |
| Intervention | Intranasal racemic ketamine |
| Dose | 75 mg |
| Duration | Single dose, assessed at 60 min, 180 min, and 1, 3, and 7 days post-treatment |
| Topics | Ketamine Esketamine |
| Keywords | Acute psychiatry Mood disorders Suicidality |
| Citations | 1 |
| Key points | Intranasal ketamine reduced acute suicidality in some cases, but no definitive conclusions about efficacy can be drawn from this pilot study. |
Abstract
Ketamine has been shown to decrease suicidality in patients with depression. However, little is known about tolerability and efficacy in heterogenous, acutely suicidal patients in emergency settings. This pilot study aimed to assess the feasibility, acceptability, and safety of generic intranasal racemic ketamine (75 mg) in the treatment of acute suicidality regardless of the underlying diagnosis, as preparation for a subsequent double-blind randomized placebo-controlled trial (RCT). From September 2021 to June 2022, 12 patients with acute suicidality were recruited. All received a single open-label dose of 75 mg intranasal racemic ketamine. Suicidality was assessed with the Beck Scale for Suicidal Ideation (BSSI), depression with the Montgomery-Åsberg Depression Rating Scale (MADRS), side effects with the Systematic Assessment for Treatment Emergent Effects (SAFTEE) and Clinician Administered Dissociative Symptom Scale (CADSS), and overall improvement with the Clinical Global Impression (CGI) at 60 min, 180 min, and at 1, 3, and 7 days post-treatment. The CADSS and SAFTEE were administered only at baseline, 60 and 180 min post intervention. Vital signs were monitored for the first 240 min post intervention. Optional blood sampling occurred at baseline and 180 min post-treatment, and Magnetic Resonance Imaging one day post intervention. Treatment was well-tolerated. We observed a downward trend in both BSSI and MADRS scores one day post treatment, though this effect declined by day seven. One patient developed ketamine misuse several weeks after participation. The treatment was generally feasible, well-tolerated and safe. Intranasal ketamine reduced acute suicidality in some cases but regarding efficacy, no definitive conclusions can be drawn from this pilot study. Amendments were made to the study protocol with extended follow-up time, investigation of drug liking and craving, less questionnaires and longer inclusion window.
Comparable studies
Other non-randomized and open-label trials on ketamine, most cited first.
Citations in the library
Cites 10
- Measurement of dissociative states with the Clinician‐Administered Dissociative States Scale (CADSS) Journal of Traumatic Stress 1998
- The effect of a single dose of intravenous ketamine on suicidal ideation: a systematic review and individual participant data meta-analysis American Journal of Psychiatry October 3, 2017
- 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
- Ketamine for suicidal ideation in adults with psychiatric disorders: A systematic review and meta-analysis of treatment trials Australian & New Zealand Journal of Psychiatry November 15, 2019
- Esketamine Treatment for Depression in Adults: A PRISMA Systematic Review and Meta-Analysis. American Journal of Psychiatry March 1, 2025
and 5 more in the library