Intravenous ketamine for suicide ideation in borderline personality and depression

This case report explores the efficacy of intravenous Ketamine in treating active suicidal ideation in a 24-year-old female with comorbid major depressive disorder (MDD), borderline personality disorder (BPD), posttraumatic stress disorder (PTSD), and functional neurological disorder (FND).

The patient, with a history of multiple suicide attempts and treatment-resistant MDD, demonstrated significant improvement following nine intravenous ketamine sessions. The Montgomery-Åsberg Depression Rating Scale score decreased from 45 to 11, accompanied by sustained reductions in impulsivity, irritability, and depressive symptoms.

This report highlights ketamine's rapid action on glutamate pathways and its potential benefits in complex psychiatric profiles where traditional treatments like electroconvulsive therapy often fail. A proposed staging model for suicidal behavior management underscores the importance of early intervention with non-classical treatments in high-risk cases.

Intravenous ketamine offers a promising therapeutic option for patients with severe suicidality and comorbidities, warranting further research on its long-term efficacy and safety.