Intravenous Ketamine Improves Symptoms of Major Depressive Disorder, Suicidality

Ketamine is a potentially life-saving option for those with major depressive disorder with borderline features.

Intravenous ketamine was found to be effective for the treatment of major depressive disorder (MDD) with or without borderline features, according to findings published in Journal of Affective Disorders.

Researchers at the University of Alabama at Birmingham recruited 153 (mean age, 36.9-42.3 years) adults with MDD. The study participants received intravenous ketamine 0.5 mg/kg over 40 minutes. Changes in Beck Depression Inventory-II (BDI-II), Hamilton Rating Scale for Depression (HRSD), and Beck Scale for Suicidal Ideation (BSS16) were evaluated up to 14 days following treatment.

Study participants had either borderline features (n=31) or no features (n=122). Those with borderline features experienced more serious suicidality and significantly lower HRSD (P =.02) and higher BDI-II (P <.001) scores.

At 14 days, BDI scores had decreased by 23.2 points for the participants with borderline features and 15.3 points for those without features (F[1130], 4.24; P =.04). The absolute changes in BDI scores did not differ on the basis of borderline features or inpatient or outpatient status.

[T]hese data indicate that ketamine is equally effective in MDD patients with and without borderline features.

The mean BSS16 score decreased more among the participants without borderline features at 14 days (mean difference [MD], -10.1) than participants with borderline features (MD, -4.7; P =.015).

Among the subset of participants with BSS16 scores of at least 10 at baseline (53.6%), the change in BSS16 scores correlated with change in BADI-II scores at 24 hours (r, 0.66; P <.001).

At 30-minutes following ketamine administration, participants had moderately high Clinician-Administered Dissociative States Scale scores, indicating dissociation.

The major limitation of this study was the lack of a comparator cohort.

Study authors concluded, “In this study, intravenous ketamine was associated with reduction in depression and suicidal ideation severity that was equivalent at 3- and 24-hours but greater at 14 days in the MDD with borderline features group than the MDD without borderline features group. However, these data indicate that ketamine is equally effective in MDD participants with and without borderline features. The results with both groups are consistent with previous studies showing symptom improvement in people with MDD within hours after ketamine treatment that lasts up to 2 weeks.”


Chen KS, Dwivedi Y, Shelton RC. The effect of IV ketamine in patients with major depressive disorder and elevated features of borderline personality disorder. J Affect Disord. 2022;315:13-16. doi:10.1016/j.jad.2022.07.054