The use of ketamine in the management of suicidal crisis: a literature review

Introduction: Suicidal crisis represents a major psychiatric emergency, often occurring in the context of mood disorders and requiring rapid, effective interventions. Traditional antidepressant treatments usually have a delayed onset of action, underscoring the need for fast-acting therapeutic alternatives. In recent years, ketamine—an NMDA receptor antagonist—has emerged as a promising option for the rapid reduction of suicidal ideation.

Objectives: This literature review aims to synthesize current evidence on the efficacy, mechanisms, and safety of ketamine and its enantiomer esketamine in the management of acute suicidal crises.

Methods: A systematic search of recent peer-reviewed studies, meta-analyses, and clinical guidelines (2015–2025) was conducted using PubMed, Scopus, and ScienceDirect. Articles assessing both intravenous ketamine and intranasal esketamine in suicidal patients were included.

Results: The reviewed literature consistently demonstrates that a single subanesthetic dose of intravenous ketamine (0.5 mg/kg) produces a rapid reduction in suicidal ideation within hours , with effects typically lasting up to one week. Esketamine nasal spray, approved for treatment-resistant depression, also shows significant short-term anti-suicidal effects when used alongside standard care. Neurobiological findings suggest that ketamine’s benefits involve glutamatergic modulation , enhanced synaptic plasticity , and downstream effects on BDNF signaling and AMPA receptor activation . However, heterogeneity in dosing protocols, short duration of benefit, and potential dissociative or cardiovascular side effects remain important limitations.

Conclusions: Ketamine represents a major paradigm shift in the acute management of suicidal crises, offering rapid-onset relief where conventional antidepressants fail. Nevertheless, its transient efficacy and the need for specialized monitoring highlight the importance of integrating ketamine into multimodal, safety-focused treatment strategies . Future research should clarify optimal dosing schedules, maintenance strategies, and long-term outcomes to fully establish ketamine’s role in suicide prevention. Disclosure of Interest None Declared