Ketamine for suicidal ideations in severe depression

A 38-year-old woman with recurrent depression and active suicidal thoughts, who had not improved on multiple medications, received a ketamine infusion. Before treatment, her depression severity score was 33 on the Hamilton Depression Rating Scale (HDRS). After one session, the score dropped to 23 and her suicidal ideation notably decreased. Ketamine acts through NMDA receptor blockade and modulation of glutamatergic transmission, a mechanism distinct from standard antidepressants. This case suggests ketamine can provide rapid symptom relief in severe depression with suicidality and is tolerable at sub-anesthetic doses.

Study at a glance

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.