The use of repetitive transcranial magnetic stimulation (rTMS), electroconvulsive therapy (ECT), ketamine, and esketamine in reducing suicidality in major depressive disorder: A comprehensive narrative review
Psychiatry Research – February 19, 2026
Source: OpenAlex
Summary
Ketamine and esketamine show significant promise in rapidly reducing suicidal ideation (SI) in individuals with major depressive disorder (MDD), with randomized controlled trials highlighting their short-term efficacy. Additionally, transcranial magnetic stimulation (rTMS) and electroconvulsive therapy (ECT) also contribute to decreased depressive symptoms. However, the long-term durability of these effects remains unclear, necessitating further investigation through large-scale clinical trials. Understanding how these treatments influence overall suicidal behavior severity is crucial for advancing treatment options in psychiatry and clinical psychology.
Abstract
Ketamine, esketamine, rTMS and ECT are associated with reductions in SI in persons with MDD, with the strongest evidence from randomized controlled trials supporting rapid, short-term effects, particularly for ketamine and esketamine. Further characterization and differentiation of the durability of antisuicidal effects of the aforementioned interventions requires investigation in large-scale, adequately-controlled clinical trials. In addition, whether reductions in SI following administration of these agents reduces the severity of aspects of suicidal behavior should be evaluated.