Is Ketamine Efficacious for Rapid Treatment of Acute Suicidal Ideation in an Emergency Setting? Lessons Learned from A Pilot Randomized Controlled Trial

Abstract Background Ketamine has emerged as a promising agent for the rapid reduction of suicidal thoughts. However, its efficacy across a broader spectrum of psychiatric disorders remains underexplored.Objective This study aimed to evaluate the efficacy of a single infusion of ketamine in inducing rapid remission of severe suicidal ideation, compared to Midazolam, in a population with acute suicidal thoughts.Methods In a double-blind randomized controlled trial conducted in Tehran, Iran, from January to July 2022 (IRCT20220118053756N1), 36 inpatients with acute severe suicidal ideation were enrolled. Participants were randomly assigned to receive either a single dose of ketamine (0.5 mg/kg) or Midazolam (0.02 mg/kg). Suicidality was assessed using the Beck Scale for Suicide Ideation (BSSI) and the Suicide-Visual Analog Scale (S-VAS) before the intervention and at 12 and 24 hours post-administration.Results At baseline, the Midazolam group exhibited significantly higher BSSI scores and a higher rate of borderline personality disorder than the Ketamine group. Mean BSSI and S-VAS scores at 12 and 24 hours after the treatment in both groups. Despite these observations, no statistically significant differences were found between the groups in terms of BSSI and S-VAS scores.Conclusions The findings suggest that ketamine may reduce suicidal ideation, but its efficacy varies by psychiatric diagnosis. The groups were not significantly different in the main study outcomes.