The following is a summary of the “Efficacy and safety of esketamine in the treatment of major depressive disorder with suicidal ideation: study protocol for a randomized controlled trial” published in the November 2022 issue of Psychiatry by Liu et al.

Up to 20 % with major depressive disorder (MDD) will attempt suicide at some point in their lives. Current treatments for MDD are characterized by a sluggish onset of action, low efficiency, and an inability to swiftly and effectively reduce suicidal tendencies. Evidence on the efficacy and safety of intravenous esketamine in lowering suicidal thoughts and depressive symptoms in MDD patients with suicidal ideation is still lacking, despite the fact that intravenous ketamine has been demonstrated to have a quick but brief antidepressant effect. 

Researchers set out to test the efficacy of 3 short courses of intravenous infusion of esketamine for treating suicidal ideation in individuals with major depressive disorder. Short-term repeated intravenous infusions of esketamine were compared with a placebo as an adjunct to standard antidepressants in this randomized, double-blind, placebo-controlled trial (RCT), with an intervention period of 6 days and one infusion every other day, followed by 4 weeks of follow-up. Short-term, repeated intravenous infusions of esketamine in MDD patients with suicidal ideation are supported by these approaches for investigating the efficacy, safety, tolerability, and mechanism of action.

This is the first randomized controlled trial to examine the effects of repeated short-term infusions of esketamine on suicidal thoughts and depressive symptoms in people with MDD. If successful and well tolerated, it will show that suicidal ideation and depressive symptoms may be rapidly and effectively treated in people with MDD.