The use of repetitive transcranial magnetic stimulation (rTMS), electroconvulsive therapy (ECT), ketamine, and esketamine in reducing suicidality in major depressive disorder: A comprehensive narrative review
Trisha Menon, Andy Lu, Akhilan Arulmozhi, Christine E. Dri, Sabrina Wong, Kayla M. Teopiz, Gia Han Le, Serene M. L. Lee, Cory R. Weissman, Roger S. McIntyre
Psychiatry Research February 19, 2026 DOI: 10.1016/j.psychres.2026.117036 via OpenAlex
Summary
AI-generated from the abstractKetamine, esketamine, repetitive transcranial magnetic stimulation (rTMS), and electroconvulsive therapy (ECT) are associated with reductions in suicidal ideation in people with major depressive disorder. The strongest evidence from randomized controlled trials supports rapid, short-term effects, particularly for ketamine and esketamine. Further research is needed to characterize the durability of these antisuicidal effects and to determine whether reductions in suicidal ideation translate into reduced severity of suicidal behavior.
Study at a glance
| Characteristics | Narrative review Randomized Peer reviewed |
|---|---|
| Population | Persons with major depressive disorder |
| Interventions | Ketamine Esketamine rTMS ECT |
| Topics | Depression Ketamine |
| Keywords | Narrative review Transcranial magnetic stimulation Psychological intervention Randomized controlled trial |
| Key finding | Ketamine, esketamine, rTMS, and ECT are associated with reductions in suicidal ideation in people with major depressive disorder, with the strongest evidence supporting rapid, short-term effects for ketamine and esketamine. |
Abstract
Ketamine, esketamine, rTMS and ECT are associated with reductions in SI in persons with MDD, with the strongest evidence from randomized controlled trials supporting rapid, short-term effects, particularly for ketamine and esketamine. Further characterization and differentiation of the durability of antisuicidal effects of the aforementioned interventions requires investigation in large-scale, adequately-controlled clinical trials. In addition, whether reductions in SI following administration of these agents reduces the severity of aspects of suicidal behavior should be evaluated.