EFFECTS OF KETAMINE AND ESKETAMINE ON SUICIDAL IDEATION WITHIN THE FIRST 24 HOURS IN ADULTS WITH DEPRESSIVE DISORDERS: VARIABILITY IN CLINICAL FINDINGS AND INTERPRETATIVE CHALLENGES - A NARRATIVE REVIEW

Marta Borkowska; Małgorzata Witaszczyk; Alicja Sołtan; Natalia  Wiktorzak; Julia  Lipska; Jagoda Prządka; Dominika  Kochan-Olszewska; Longin Rudnicki; Jakub Pawlicki; Justyna Laskus; Marta  Sielatycka; Gracjan Koźma; Paweł Klimas; Bartosz  Gawior; Olga  Stasiak; Wiktoria Bukowska; Karolina Przybylska-Pawlinow; Jakub Przybylski-Pawlinow

doi:10.31435/ijitss.3(51).2026.6636

Authors

Marta Borkowska Military Institute of Medicine - National Research Institute, Szaserów 128, 04-141 Warsaw, Poland https://orcid.org/0009-0002-8105-3384
Małgorzata Witaszczyk University Clinical Center of the Medical University of Silesia in Katowice, Medyków 18, 40-752 Katowice, Poland https://orcid.org/0009-0004-0197-5480
Alicja Sołtan Central Clinical Hospital of the Medical University of Warsaw, Banacha 1A, 02-097 Warsaw, Poland https://orcid.org/0009-0006-8750-0797
Natalia Wiktorzak Cardinal Stefan Wyszyński Voivodeship Hospital in Łomża, Marszałka Józefa Piłsudskiego 11, 18-400 Łomża, Poland https://orcid.org/0009-0004-8601-3087
Julia Lipska Medical University of Lublin, al. Racławickie 1, 20-059 Lublin, Poland https://orcid.org/0009-0009-4093-2543
Jagoda Prządka Nicolaus Copernicus University in Toruń Ludwik Rydygier Collegium Medicum in Bydgoszcz, Jagiellońska 15, 85-067 Bydgoszcz, Poland https://orcid.org/0009-0001-7921-919X
Dominika Kochan-Olszewska Holycross Cancer Center in Kielce, Artwińskiego 3, 25-734 Kielce, Poland https://orcid.org/0009-0002-0001-7809
Longin Rudnicki Medical University of Gdańsk, M. Skłodowskiej-Curie 3a, 80-210 Gdańsk, Poland https://orcid.org/0009-0003-8980-8718
Jakub Pawlicki Specialist Hospital St. Wojciech in Gdańsk, Aleja Jana Pawła II 50, 80-462 Gdańsk, Poland https://orcid.org/0009-0007-3888-4672
Justyna Laskus Bielański Hospital, Cegłowska 80, 01-809 Warsaw, Poland https://orcid.org/0009-0004-8065-0464
Marta Sielatycka Medical University of Lodz; Al. Kościuszki 4, 90-419 Łódź, Poland https://orcid.org/0009-0000-3525-9459
Gracjan Koźma Military Institute of Aviation Medicine, 54/56 Krasińskiego Street, 01-755 Warsaw, Poland https://orcid.org/0009-0002-8812-6427
Paweł Klimas Św. Wincentego a Paulo Hospital, 1 Wójta Radtkego St., 81-348 Gdynia, Poland https://orcid.org/0009-0002-8803-0476
Bartosz Gawior Mazovian Bródno Hospital, Ludwika Kondratowicza 8, 03-242 Warsaw, Poland https://orcid.org/0009-0003-0935-5414
Olga Stasiak Międzylesie Specialist Hospital in Warsaw, Bursztynowa 2, 04-749 Warsaw, Poland https://orcid.org/0009-0008-3013-8015
Wiktoria Bukowska 105 Borderlands Military Hospital with Outpatient Clinic in Żary, Bolesława Domańskiego 2, 68-200 Żary, Poland https://orcid.org/0009-0005-4601-5675
Karolina Przybylska-Pawlinow 109 Military Hospital with Policlinic in Szczecin, Księdza Piotra Skargi 9/11, 71-422 Szczecin, Poland https://orcid.org/0009-0001-8540-2230
Jakub Przybylski-Pawlinow 109 Military Hospital with Policlinic in Szczecin, Księdza Piotra Skargi 9/11, 71-422 Szczecin, Poland https://orcid.org/0009-0003-9671-2431

DOI:

https://doi.org/10.31435/ijitss.3(51).2026.6636

Keywords:

Ketamine, Esketamine, Suicidal Ideation, Major Depressive Disorder, Treatment-Resistant Depression, Rapid-Acting Antidepressants, Early Treatment Response

Abstract

Background: Ketamine and esketamine have been studied as rapid-acting interventions in adults with depressive disorders and suicidal ideation, but findings vary across populations, settings, comparators, routes, and outcome measures.

Aim: To examine their effects on suicidal ideation within the first 24 hours and to identify factors contributing to variability across studies.

Methods: This narrative review used a structured PubMed and Scopus search for English-language studies published from January 2000 through April 30, 2026. Clinical trials and relevant secondary studies were considered. No formal risk-of-bias assessment or quantitative synthesis was performed.

Results: Intravenous ketamine studies reported rapid reductions in suicidal ideation, although findings were inconsistent. One midazolam-controlled trial showed a 4.96-point greater reduction in the Scale for Suicide Ideation score at 24 hours, whereas another found no significant difference in the primary Beck Scale for Suicide Ideation outcome. Intranasal esketamine added to intensive standard-of-care treatment improved depressive symptoms at 24 hours, but clinician-rated suicidality did not differ significantly between groups in either ASPIRE trial.

Conclusions: Intravenous ketamine may rapidly reduce suicidal ideation in selected adults. Intranasal esketamine has shown clearer early effects on depressive symptoms than on suicidality-specific outcomes. Standardized measures and longer follow-up are needed.

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