Case report of S-ketamine as treatment option for suicidal ideation and treatment-resistant depression in adolescents with early-onset psychosis
Nicolas Schmelzle, Katrin Neubacher, Paul L. Plener, Christian Scharinger
Neuropsychiatrie August 25, 2026 DOI: 10.1007/s40211-026-00587-1 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Case study Case report Peer reviewed |
|---|---|
| Sample size | 1 |
| Population | 16-year-old male with schizophrenia (ICD-10: F20.9) and chronic suicidality |
| Interventions | S-ketamine Amisulpride |
| Dose | titrated to 84 mg |
| Measures | Montgomery-Åsberg Depression Rating Scale (MADRS), Positive and Negative Syndrome Scale (PANSS) |
| Topics | Depression Esketamine Ketamine |
| Key findings | Intranasal S-ketamine (titrated to 84 mg) produced a rapid clinical response in an adolescent with early-onset psychosis and treatment-resistant depressive symptoms, with MADRS score reduced by 50% within 3 weeks and PANSS subscale scores reduced (positive from 22 to 10, negative from 33 to 17), without exacerbation of positive symptoms. |
Abstract
Background: Depressive symptoms and suicidality are highly prevalent in adolescents with early-onset psychosis (EOP) and often remain refractory to standard treatment. While S‑ketamine is an established treatment for treatment-resistant depression in adults (TRD), its use in primary psychotic disorders remains scarce due to risk of exacerbation of psychotic symptoms. CASE PRESENTATION: We present the case of a 16-year-old male with schizophrenia (ICD-10: F20.9) and chronic suicidality. Despite achieving remission of positive symptoms with amisulpride, severe depressive symptoms including suicidality persisted. Following the initiation of off-label intranasal S‑ketamine (titrated to 84 mg) at age 17 and 11 months, the patient showed a rapid clinical response. The Montgomery-Åsberg Depression Rating Scale (MADRS) score decreased by 50% within 3 weeks, accompanied by a significant reduction in the Positive and Negative Syndrome Scale (PANSS)-positive symptoms subscale score (from 22 to 10) and the PANSS-negative symptoms subscale score (from 33 to 17). Notably, no exacerbation of remitted positive symptoms occurred, and sustained functional recovery was achieved.
Conclusion: This case suggests that intranasal S‑ketamine may be a safe and effective augmentation strategy for TRD and suicidality in stable adolescent early-onset psychosis, highlighting the need for further research in this high-risk population.