Established in adults, but testing in teens is in its infancy
STUDY: Onikashvili Y et al, Can J Emerg Med 2026
STUDY TYPE: Pilot randomized controlled trial
FUNDING: BC Children’s Hospital Foundation (philanthropic)
Background
Ketamine works fast in suicidality in adults, but studies in teens are few.
The Study
- 15 adolescents ages 10–17 hospitalized for suicidal ideation.
- Randomized 1:1:1 to intravenous ketamine (0.5 mg/kg), midazolam (0.03 mg/kg, used to disguise the placebo), or saline (as an inert placebo), triple-blinded, infused over 40 minutes.
- Of 21 eligible patients when staffing allowed, 15 enrolled
- Suicidal ideation was measured at 90 minutes using the Columbia Suicide Severity Rating Scale (C-SSRS), the Montgomery-Åsberg Depression Rating Scale suicide item, and a 0–10 self-rated Likert scale, with follow-up out to 28 days.
Results
At 90 minutes, the ketamine group showed the largest drops in suicidal ideation scores. On the Likert scale, scores fell a median of 2 points from a starting point of 9 in the ketamine group, versus 1 point in the midazolam group and 1 point in the saline group.
Retention at 28 days was 73%. The confidence intervals are wide because of the small sample, and this trial wasn’t designed to prove ketamine works; it was designed to show a larger trial is doable.
Side Effects
Ketamine linked to increased sociability (4 of 5), positivity (3 of 5), emotional lability (2 of 5), and dizziness (1 of 5). No serious adverse events occurred.
Limitations
Small size means a lot of uncertainty.
Practice Implications
This is a feasibility trial. The next step is a multicenter efficacy trial, underway at ClinicalTrials.gov (NCT04955470).
—Chris Aiken, MD
Director, Psych Partners
Editor in Chief, Carlat Psychiatry Report
