Intravenous Ketamine for Depressed and Suicidal Adolescents in the Emergency Department: A Randomized Double-Blind Trial.
6 affiliations
- 1University of California, San Diego School of Medicine, Department of Pediatrics, Division of Emergency Medicine, La Jolla, California.
- 2Rady Children's Hospital San Diego, San Diego, California.
- 3University of California, San Diego School of Medicine, Department of Psychiatry, La Jolla, California.
- 4New York-Presbyterian/Weill Cornell Medicine, Department of Psychiatry, New York, New York.
- 5Stanford University, Department of Psychiatry, Stanford, California.
- 6Rady Children's Hospital, Department of Pharmacy, San Diego, California.
Abstract
Introduction
Adolescents frequently seek care in the emergency department (ED) for behavioral health emergencies. Due to national shortages in staffing, limited opportunities to begin treatment on site in most centers and, thus, the frequent default to elusive inpatient psychiatric beds as a means of stabilization, adolescents may spend prolonged amounts of time boarding in the ED, often without treatment. Ketamine is a rapid-acting antidepressant with emerging evidence in adults, but data are limited on its effectiveness in suicidal youth. We aimed to evaluate the effectiveness of a single dose of intravenous (IV) ketamine on depression and suicidality scores compared to placebo in adolescents with treatment-resistant depression presenting to the ED with suicidal ideation.Methods
We conducted a two-arm randomized double-blind placebo controlled trial on a convenience sample of adolescents 12-17 years of age with treatment-resistant depression (trialed at least two antidepressants for at least four weeks each) who presented to the ED with suicidal ideation requiring psychiatric admission. Exclusion criteria included psychosis, substance abuse disorder, intoxication, developmental delay, aggressive behavior, and medical contraindications to ketamine. Subjects were randomized to receive a single dose of ketamine (0.2 mg/kg IV, maximum 35 mg) or saline placebo over two minutes. They completed the Beck Youth Inventory (BYI) and Suicidal Ideation Questionnaire (SIQ) at baseline and at 1 hour, 3 hours, 1 day, 3 days, and 7 days post-treatment. We compared groups with the Fisher exact and two-sided rank-sum tests. Our primary outcome measure was the proportion of subjects with a reduction of ≥ 50% on the BYI and SIQ within 3 hours after treatment.Results
The 29 subjects (14 placebo, 15 ketamine) did not differ significantly in demographic and clinical characteristics. Despite reductions in BYI and SIQ in both groups, the proportions achieving ≥ 50% reductions did not differ significantly at 1 hour (SIQ: placebo, 0% vs ketamine 14.3 % [P = .48]; BYI Anxiety Inventory: placebo, 0% vs ketamine 21.4% [P = .22]; BYI Depression Inventory: placebo, 0% vs ketamine 15.4% [P = .22]). Differences at 3 hours were less pronounced. Adverse effects were more frequent in the ketamine group, most notably signs of dissociation (7% vs 60%, P = .004), with none after the 1-hour observation period.Conclusion
The ED offers an opportunity to deliver rapid-acting antidepressant treatment for suicidal adolescents. Although low-dose ketamine was not associated with greater reductions in depression or suicidality than placebo, this study demonstrated feasibility and highlights the need for larger studies to determine optimal ketamine dosing, route of administration, and implementation strategies in the ED setting.
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BibTeX
@article{vayngortin2026intravenous,
title = {{Intravenous Ketamine for Depressed and Suicidal Adolescents in the Emergency Department: A Randomized Double-Blind Trial.}},
author = {Tatyana Vayngortin and Ekta Patel and Shamilka Seneviratne and Daniel Lowet and Christian D Saavedra Chavez and Christine Chau and Kathryn Hollenbach and Fareed Saleh and John Kanegaye},
journal = {The western journal of emergency medicine},
year = {2026},
month = jul,
doi = {10.5811/westjem.53968},
url = {https://europepmc.org/article/MED/42900929},
note = {CC BY},
}
RIS
TY - JOUR
TI - Intravenous Ketamine for Depressed and Suicidal Adolescents in the Emergency Department: A Randomized Double-Blind Trial.
AU - Tatyana Vayngortin
AU - Ekta Patel
AU - Shamilka Seneviratne
AU - Daniel Lowet
AU - Christian D Saavedra Chavez
AU - Christine Chau
AU - Kathryn Hollenbach
AU - Fareed Saleh
AU - John Kanegaye
PY - 2026
DA - 2026/07/28
JO - The western journal of emergency medicine
DO - 10.5811/westjem.53968
UR - https://europepmc.org/article/MED/42900929
AB - Introduction Adolescents frequently seek care in the emergency department (ED) for behavioral health emergencies. Due to national shortages in staffing, limited opportunities to begin treatment on site in most centers and, thus, the frequent default to elusive inpatient psychiatric beds as a means of stabilization, adolescents may spend prolonged amounts of time boarding in the ED, often without treatment. Ketamine is a rapid-acting antidepressant with emerging evidence in adults, but data are limited on its effectiveness in suicidal youth. We aimed to evaluate the effectiveness of a single dose of intravenous (IV) ketamine on depression and suicidality scores compared to placebo in adolescents with treatment-resistant depression presenting to the ED with suicidal ideation.Methods We conducted a two-arm randomized double-blind placebo controlled trial on a convenience sample of adolescents 12-17 years of age with treatment-resistant depression (trialed at least two antidepressants for at least four weeks each) who presented to the ED with suicidal ideation requiring psychiatric admission. Exclusion criteria included psychosis, substance abuse disorder, intoxication, developmental delay, aggressive behavior, and medical contraindications to ketamine. Subjects were randomized to receive a single dose of ketamine (0.2 mg/kg IV, maximum 35 mg) or saline placebo over two minutes. They completed the Beck Youth Inventory (BYI) and Suicidal Ideation Questionnaire (SIQ) at baseline and at 1 hour, 3 hours, 1 day, 3 days, and 7 days post-treatment. We compared groups with the Fisher exact and two-sided rank-sum tests. Our primary outcome measure was the proportion of subjects with a reduction of ≥ 50% on the BYI and SIQ within 3 hours after treatment.Results The 29 subjects (14 placebo, 15 ketamine) did not differ significantly in demographic and clinical characteristics. Despite reductions in BYI and SIQ in both groups, the proportions achieving ≥ 50% reductions did not differ significantly at 1 hour (SIQ: placebo, 0% vs ketamine 14.3 % [P = .48]; BYI Anxiety Inventory: placebo, 0% vs ketamine 21.4% [P = .22]; BYI Depression Inventory: placebo, 0% vs ketamine 15.4% [P = .22]). Differences at 3 hours were less pronounced. Adverse effects were more frequent in the ketamine group, most notably signs of dissociation (7% vs 60%, P = .004), with none after the 1-hour observation period.Conclusion The ED offers an opportunity to deliver rapid-acting antidepressant treatment for suicidal adolescents. Although low-dose ketamine was not associated with greater reductions in depression or suicidality than placebo, this study demonstrated feasibility and highlights the need for larger studies to determine optimal ketamine dosing, route of administration, and implementation strategies in the ED setting.
SN - 1936-900X
SN - 1936-9018
ER -