Intravenous Ketamine for Depression and Suicidality in Borderline Personality Disorder and Borderline Personality Features: A Systematic Review
Annie Xiong, Sebastian Kolde, Paul Links
McMaster University Medical Journal July 26, 2026 DOI: 10.15173/mumj.v22i2.4182 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Systematic review Peer reviewed |
|---|---|
| Population | Adults with formally diagnosed borderline personality disorder |
| Intervention | Ketamine |
| Topics | Depression Esketamine Ketamine |
| Key findings | Evidence for ketamine in formally diagnosed BPD is limited to two studies. Ketamine was generally well tolerated, with transient dissociative effects. Antidepressant and antisuicidal effects were suggestive but not definitive: an RCT showed non-significant improvements after a single infusion, while an observational study reported significant reductions after repeated infusions without a placebo comparator. Findings on core BPD symptoms were mixed. |
Abstract
Background: Pharmacologic treatment options for borderline personality disorder (BPD) remain limited, and no medication has received regulatory approval for its treatment. Given the high rates of comorbid depression and suicidal ideation in BPD, there is growing interest in novel therapeutic approaches. Ketamine has been approved for treatment-resistant depression and acute suicidality, raising interest in its potential role for BPD patients.
Objective: To systematically review the evidence on the effectiveness and tolerability of ketamine for depressive symptoms, suicidal ideation, and core BPD symptoms in adults with formally diagnosed BPD.
Methods: MEDLINE, EMBASE, and Cochrane CENTRAL were systematically searched. Studies examining ketamine treatment in adults with a formal BPD diagnosis and reporting outcomes related to depression, suicidality, or BPD symptomatology were included. A narrative synthesis was performed due to study heterogeneity.
Results: The search yielded 1,620 abstracts, with eight full-text studies reviewed. Two studies met inclusion criteria: one RCT and one real-world observational cohort study. Ketamine was generally well tolerated, with transient dissociative effects and no unexpected safety concerns. Evidence for antidepressant and antisuicidal effects was suggestive but not definitive: the RCT demonstrated numerical but non-significant improvements following a single infusion, whereas the observational study reported significant symptom reductions following repeated infusions without a placebo comparator. Findings regarding core BPD symptoms were mixed.
Conclusions: Evidence for ketamine in formally diagnosed BPD remains limited. Preliminary findings suggest ketamine is tolerable and may be associated with improvements in depressive symptoms and suicidality, but causal inference is constrained by study design. Larger, BPD-targeted trials with stratified outcome reporting are needed.