RCT · 2026
Pilot trial of a single ketamine infusion for teens with suicidal thoughts in the ER
- Original title
- Single dose IV ketamine for adolescent suicidal ideation in the emergency department: a pilot randomized trial.
- Authors
- Schlegelmilch M, Plint AC, Barrowman N, et al.
- Journal
- BMC psychiatry, 2026
- Molecules
- Ketamine
- Conditions
- Suicidal ideation, Depression
- Participants
- 20
- Evidence grade
- Very low
- Source
- Read the original paper
The question
Is it practical to run a trial of a single intravenous ketamine infusion for adolescents who come to the emergency department with suicidal thoughts, and are there early signs of benefit?
What they did
Researchers enrolled 20 medically stable adolescents aged 12 to 17 with moderate-to-severe suicidal thoughts at an emergency department between January and May 2024. Participants were randomly assigned, with neither they nor staff knowing which they got, to receive either ketamine (0.5 mg/kg, up to 50 mg) or salt water placebo through a vein over 40 minutes. They were monitored for 120 minutes and then received usual emergency mental health care. The main goal was feasibility (whether people could be enrolled and followed up); suicidal thought severity 40 minutes after the infusion was the main clinical measure, using three standard rating scales.
What they found
All 20 participants completed the infusion and the day-1 follow-up, and 90% completed the day-7 follow-up. No serious adverse events occurred. Suicidal thought severity at 40 minutes did not differ significantly between the ketamine and placebo groups on any of the three scales (p = 0.06, 0.19 and 0.18). Fewer teens in the ketamine group were admitted to hospital at that first visit, a difference of 40 percentage points (95% confidence interval 7 to 69%).
The fine print
With only 20 participants, this study was designed to test whether such a trial can be run, not to measure whether ketamine works; the differences in suicidal thought scores were not statistically significant and the hospital admission finding is based on very few people and a wide range of uncertainty. Follow-up was short, at most 30 days for emergency revisits. The trial took place at a single emergency department over a few months. This summary is based on the abstract alone.
What it means
It appears practical to study a single ketamine infusion in adolescents with suicidal thoughts in the emergency setting, but this pilot cannot show whether the treatment actually helps; larger trials are needed.
Evidence grade: Very low. A 20-person feasibility pilot randomized trial, too small to reliably detect or rule out clinical benefit.
This summary is based on the study’s published abstract.