Effect of intravenous ketamine on suicidality in adults with treatment-resistant depression: A real world effectiveness study.
David C J Chen-Li, Rodrigo B. Mansur, Joshua D. Di Vincenzo, Noah Chisamore, Erica Kaczmarek, Roger S McIntyre, Joshua D. Rosenblat
Psychiatry Research 2025 DOI: 10.1016/j.psychres.2024.116282 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Retrospective chart analysis Peer reviewed |
|---|---|
| Sample size | 96 |
| Population | Adult treatment-resistant depression patients in a private community clinic in Toronto, Ontario |
| Intervention | Ketamine |
| Topics | Ketamine Depression Esketamine |
| Keywords | Antisuicidal effects Suicidal ideation Ketamine therapy Suicide prevention Mental health treatment Clinical research |
| Citations | 6 |
| Key points | A single ketamine infusion significantly reduced suicidal ideation in a real-world setting, with antisuicidal effects partially independent of antidepressant effects. |
Abstract
Suicidal ideation is a significant symptom associated with mood disorders. Ketamine is an emerging treatment with rapid and robust antidepressant and antisuicidal effects observed in clinical trial populations. Herein we assessed the real-world effectiveness of ketamine in ameliorating suicidality. A retroactive chart analysis of 96 adult TRD patients that received treatment in a private community clinic in Toronto, Ontario was conducted. Suicidality and depressive symptom outcomes were assessed with the Columbia Suicide Severity Rating Scale (C-SSRS) (self-report version) and the Quick Inventory for Depressive Symptomatology Self-Report 16-Item (QIDS-SR16) respectively. The effect of ketamine on suicidal ideation was modelled using generalized estimating equations adjusting for demographic predictors and depressive symptom severity. A mediation analysis was conducted to evaluate the contribution of the antidepressant effects of ketamine on its antisuicidal properties. Mean C-SSRS score significantly decreased following a single ketamine infusion and was indicative of a reduction in suicidality from active to passive suicidal ideation on a group level. Results of the mediation analysis indicated that the antisuicidal effects of ketamine are partially independent of its antidepressant effects. Our study supports the use of ketamine in treating suicidal ideation in a real-world setting with benefits comparable to clinical trials.
Comparable studies
Other observational and cohort studies on ketamine for depression, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Concomitant BDNF and sleep slow wave changes indicate ketamine-induced plasticity in major depressive disorder Patients with treatment-resistant major depressive disorder | 2012 | Observational cohort | n = 30 |
| Altered peripheral immune profiles in treatment-resistant depression: response to ketamine and prediction of treatment outcome Healthy controls and actively depressed patients with treatment-resistant depression... | 2017 | Observational cohort | n = 59 |
| Clinical Predictors of Ketamine Response in Treatment-Resistant Major Depression Treatment-resistant inpatients with DSM-IV-TR-diagnosed major depressive disorder or... | 2014 | Post hoc analysis of pooled data from four studies | n = 108 |
| An investigation of amino-acid neurotransmitters as potential predictors of clinical improvement to ketamine in depression Drug-free patients with major depressive disorder | 2011 | Observational cohort | n = 14 |
| Efficacy of ketamine therapy in the treatment of depression Drug-free/naïve men with severe depression, no history of psychotic disorder, head... | 2019 | Observational cohort | n = 25 |
Citations in the library
Cited by 4
- A systematic review of ketamine and esketamine-induced long-term potentiation and synaptic scaling: Do the molecular and synaptic plasticity effects inform dosing intervals? Journal of Affective Disorders April 15, 2026
- Nonresponse to Ketamine in Treatment‐Resistant Bipolar Depression Neuropsychopharmacology Reports July 20, 2025
- Distinct therapeutic profiles of ketamine in treatment-resistant depression: an exploratory analysis. The International Journal of Neuropsychopharmacology May 3, 2026
- Efficacy and safety of ketamine maintenance therapy in treatment-resistant depression: A systematic review of treatment protocols and clinical outcomes. Journal of Affective Disorders October 1, 2025
Cites 9
- 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
- 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
- Rapid Resolution of Suicidal Ideation After a Single Infusion of anN-Methyl-D-Aspartate Antagonist in Patients With Treatment-Resistant Major Depressive Disorder The Journal of Clinical Psychiatry July 13, 2010
- Ketamine for rapid reduction of suicidal thoughts in major depression: a midazolam-controlled randomized clinical trial American Journal of Psychiatry December 5, 2017
- Ketamine versus ECT for Nonpsychotic Treatment-Resistant Major Depression. New England Journal of Medicine May 24, 2023
and 4 more in the library