Single dose IV ketamine for adolescent suicidal ideation in the emergency department: a pilot randomized trial
Michael Schlegelmilch, Amy C. Plint, Nicholas Barrowman, Clare Gray, Tyrus Crawford, Stephen A. Kutcher, Maala Bhatt
BMC Psychiatry April 6, 2026 DOI: 10.1186/s12888-026-08042-9 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Randomized controlled trial (pilot) Placebo-controlled Double-blind Pilot study Peer reviewed |
|---|---|
| Sample size | 20 |
| Population | Adolescents aged 12 to 17 years with moderate-to-severe suicidal ideation in the emergency department |
| Intervention | Ketamine |
| Dose | 0.5 mg/kg (max 50 mg) |
| Duration | 40-minute infusion, 120-minute monitoring, 30-day follow-up |
| Measures | Beck Scale for SI (SSI5), Montgomery-Asberg Depression Rating Scale item 10 (MADRS10), Beck Depression Inventory item 9 (BDI9) |
| Topics | Esketamine Ketamine |
| Registration | NCT06366334 |
| Key findings | The trial was feasible with high follow-up rates and no serious adverse events. SI severity did not differ significantly between groups at 40 minutes, but fewer ketamine-treated participants were hospitalized at the initial visit (risk difference 40%, 95% CI: 7, 69%). |
Abstract
Background: Suicidal ideation (SI) is a common reason for emergency department (ED) visits by adolescents. While intravenous (IV) ketamine rapidly reduces SI in adults, its efficacy in adolescents remains unstudied. We assessed the feasibility of a trial of a single dose IV ketamine to reduce adolescent SI in the ED.
Methods: This double-blind, randomized, placebo-controlled pilot trial was conducted from Jan-May 2024. Medically stable adolescents aged 12 to 17 years with moderate-to-severe SI were eligible. Participants were randomized to IV ketamine (0.5 mg/kg; max 50 mg) or IV normal saline (0.5 ml/kg; max 50 mL), infused over 40 min. They were monitored for 120 min and then received usual ED mental health care. The primary outcome was trial feasibility (enrolment and follow-up success). The primary clinical outcome was SI severity at 40 min post-infusion (T-40), measured using the Beck Scale for SI (SSI5), Montgomery-Asberg Depression Rating Scale item 10 (MADRS10) and Beck Depression Inventory item 9 (BDI9). Additional outcomes included hospital admission, adverse events, 30-day ED revisits and death.
Results: Twenty participants were eligible and were enrolled. All participants completed the infusion and day-1 follow-up; 90% completed day-7 follow-up. No serious adverse events occurred. While SI severity did not differ significantly between groups at T-40 (SSI5: p = 0.06; MADRS10: p = 0.19; BDI9: p = 0.18), fewer participants randomized to ketamine were hospitalized at the initial visit (risk difference 40%, 95%CI: 7, 69%).
Conclusions: Recruiting adolescents to an ED-based IV ketamine study for SI is feasible. A larger trial is needed to clarify potential clinical benefits.
Trial Registration: ClinicalTrials.gov ID NCT06366334 (Registered 20240412).