A scoping review of nine studies identified interventions for treating acute suicidality in emergency departments (EDs) that were tested between 2013 and 2023. Four studies tested a single dose of ketamine, three tested brief psychosocial interventions (two with follow-up care), and two tested motivational interviewing. The interventions with the strongest evidence and best fit for the ED environment were ketamine and Crisis Response Planning (CRP). However, the included studies had small sample sizes (average 57 participants), and there is currently insufficient evidence to conclude that these interventions are effective and well-suited for routine ED use. Further research is needed.
A systematic review of eight studies with 141 subjects found that ketamine administration for procedural sedation frequently triggered electrographic seizures in people with epilepsy, but never in those without. Among 94 subjects with epilepsy, 28% had seizures detectable on EEG after ketamine, compared with 0% of 39 subjects without epilepsy. Clinical excitatory movements were also more common in the epilepsy group (14% vs 5%) and were usually time-linked to the EEG seizures. Children with epilepsy appeared more susceptible than adults. The authors suggest clinicians consider a patient's seizure history when discussing the risks and benefits of ketamine sedation.