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Intravenous ketamine for suicide ideation in borderline personality and depression.

Yara Bachir, Raymond Kassab, C. Hallal, Colin Cordahi, Charline El Hachem, R. Bou Khalil

L'Encephale August 1, 2025 DOI: 10.1016/j.encep.2025.04.008 (opens in new tab)

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Study at a glance

AI-extracted from the abstract
Characteristics Case study Case report Peer reviewed
Sample size 1
Population 24-year-old female with comorbid major depressive disorder, borderline personality disorder, posttraumatic stress disorder, and functional neurological disorder, with a history of multiple suicide attempts and treatment-resistant depression
Intervention Ketamine
Duration Nine intravenous ketamine sessions
Measures Montgomery-Åsberg Depression Rating Scale
Topics Depression Esketamine Ketamine
Key findings Following nine intravenous ketamine sessions, the patient's Montgomery-Åsberg Depression Rating Scale score decreased from 45 to 11, with sustained reductions in impulsivity, irritability, and depressive symptoms. The authors argue that ketamine's rapid action on glutamate pathways may benefit complex psychiatric profiles where treatments such as electroconvulsive therapy fail, and propose a staging model emphasizing early intervention with non-classical treatments in high-risk cases.

Abstract

Objective: This case report explores the efficacy of intravenous Ketamine in treating active suicidal ideation in a 24-year-old female with comorbid major depressive disorder (MDD), borderline personality disorder (BPD), posttraumatic stress disorder (PTSD), and functional neurological disorder (FND). CASE DESCRIPTION The patient, with a history of multiple suicide attempts and treatment-resistant MDD, demonstrated significant improvement following nine intravenous ketamine sessions. The Montgomery-Åsberg Depression Rating Scale score decreased from 45 to 11, accompanied by sustained reductions in impulsivity, irritability, and depressive symptoms.

Discussion: This report highlights ketamine's rapid action on glutamate pathways and its potential benefits in complex psychiatric profiles where traditional treatments like electroconvulsive therapy often fail. A proposed staging model for suicidal behavior management underscores the importance of early intervention with non-classical treatments in high-risk cases.

Conclusion: Intravenous ketamine offers a promising therapeutic option for patients with severe suicidality and comorbidities, warranting further research on its long-term efficacy and safety.

Comparable studies

Other case reports and case series on ketamine for depression, most cited first.

Study Year Design Participants
Electroconvulsive Therapy, Ketamine, and Esketamine in a Patient with Major Depressive Disorder and Multiple Comorbidities: A Case Report over 10-year Treatment from Adolescence to Adulthood. A patient with treatment-resistant depression and comorbid generalized anxiety... 2025 Case report n = 1
Oral Administration of the NMDA Receptor Antagonist S-Ketamine as Add-On Therapy of Depression: A Case Series Four depressed patients taking standard antidepressants 2009 Case series n = 4
A longitudinal case series of IM ketamine for patients with severe and enduring eating disorders and comorbid treatment‐resistant depression Patients with enduring eating disorders and treatment-resistant depression 2021 Case series n = 4
Effects of intranasal (S)-ketamine on Veterans with co-morbid treatment-resistant depression and PTSD: A retrospective case series Veterans with co-morbid depression and PTSD 2022 Retrospective case series n = 35
Case report: Intramuscular ketamine or intranasal esketamine as a treatment in four patients with major depressive disorder and comorbid anorexia nervosa Patients with anorexia nervosa and a comorbid depressive disorder treated at a private... 2023 Case report n = 4

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Depression Esketamine Ketamine PTSD

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