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Ketamine Reduces Suicidality-Associated Emergency Department Utilization in Patients With Treatment-Resistant
Liliana Patarroyo-Rodriguez1, Vanessa K Pazdernik2, Jennifer L Vande Voort1
1Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota.
The Journal of Clinical Psychiatry
|September 18, 2025
Summary
Ketamine and esketamine significantly reduced emergency department visits for suicidality in patients with treatment-resistant depression (TRD). This 6-month study highlights their long-term impact on reducing healthcare utilization for suicidal ideation.
Area of Science:
- Psychiatry
- Pharmacology
- Health Services Research
Background:
- Short-term studies indicate ketamine/esketamine possess antisuicidal properties in treatment-resistant depression (TRD).
- Limited long-term data exist regarding the impact of ketamine/esketamine on healthcare utilization for suicidality in TRD patients.
- This study investigates the effect of acute ketamine/esketamine treatment on emergency department (ED) visits for suicidality over six months in a TRD cohort.
Purpose of the Study:
- To compare the frequency of suicidality-associated ED visits in TRD patients during the six months before and after acute ketamine/esketamine treatment.
- To evaluate the long-term impact of ketamine/esketamine on reducing healthcare utilization related to suicidal behaviors in TRD.
Main Methods:
- A mirror-image study design was employed, analyzing data from adults with TRD treated between May 2018 and May 2024.
- The primary outcome was the number of ED visits for suicidality in the six months pre- and post-treatment with intravenous (IV) ketamine or intranasal (IN) esketamine.
- A negative binomial mixed-effects model was used to calculate incidence rate ratios (IRRs) for changes in ED visit frequency.
Main Results:
- Analysis included 97 patients (69% female, median age 48.9 years) with major depressive disorder (97%).
- Following acute treatment, ED visits for suicidal ideation decreased by 84% (IRR=0.16, P=.001).
- Overall ED visits for suicidality decreased by 63% (IRR=0.37, P=.007) post-treatment.
Conclusions:
- Ketamine and esketamine treatments were associated with a significant reduction in long-term ED visits for suicidality in individuals with TRD.
- These findings suggest potential benefits of ketamine/esketamine in reducing acute care utilization for suicidal crises in TRD.
- Further research with longer follow-up is warranted to determine if these effects are mood-dependent or mediated by independent mechanisms.
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