EPV577 - The use of ketamine in the management of suicidal crisis: a literature review

EPV577

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

A. Rami ^1,*

¹Razi Hospital, Manouba, Tunisia

 

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