Ketamine for suicidal ideations in severe depression
Adesh University Journal of Medical Sciences & Research – September 25, 2025
Source: OpenAlex
Summary
A 38-year-old woman with severe recurrent depressive disorder and active suicidal ideations experienced significant improvement after ketamine infusion. Initially, her Hamilton Depression Rating Scale (HDRS) score was 33, indicating severe depression. Following one session of ketamine treatment, her score dropped to 23, reflecting a reduction in depressive symptoms and suicidal thoughts. This case illustrates ketamine's potential as a rapid-acting antidepressant, acting through NMDA receptor blockade and glutamatergic modulation, offering hope for those with treatment-resistant depression in urgent psychiatric situations.
Abstract
This case report describes the management of a 38-year-old female with recurrent depressive disorder, who presented with severe depressive symptoms and active suicidal ideations. She reported persistent low mood, loss of interest in pleasurable activities, fatigue, and disturbed sleep for nearly three weeks, with recurrent thoughts of ending her life in the preceding week. Despite being on multiple psychotropic medications including lamotrigine, desvenlafaxine, mirtazapine, and benzodiazepines, her symptoms had worsened, warranting urgent intervention. On admission, her Hamilton Depression Rating Scale (HDRS) score was 33, indicating severe depression. In view of high suicidal risk and inadequate response to ongoing treatment, ketamine infusion was planned as a rapid-acting antidepressant strategy. Following the first session, her HDRS score reduced to 23, accompanied by a noticeable decline in suicidal ideations. This improvement highlights the potential of ketamine as a fast-acting therapeutic option in cases of severe depression with suicidality. Acting through NMDA receptor blockade and modulation of glutamatergic transmission, ketamine offers a novel mechanism distinct from conventional antidepressants. The case supports the growing evidence base for the use of ketamine in psychiatric emergencies where rapid symptom relief is critical and underscores its tolerability at sub-anesthetic doses.