Intravenous ketamine for suicide ideation in borderline personality and depression.

Objective: This case report explores the efficacy of intravenous Ketamine in treating active suicidal ideation in a 24-year-old female with comorbid major depressive disorder (MDD), borderline personality disorder (BPD), posttraumatic stress disorder (PTSD), and functional neurological disorder (FND).

Case description: The patient, with a history of multiple suicide attempts and treatment-resistant MDD, demonstrated significant improvement following nine intravenous ketamine sessions. The Montgomery-Åsberg Depression Rating Scale score decreased from 45 to 11, accompanied by sustained reductions in impulsivity, irritability, and depressive symptoms.

Discussion: This report highlights ketamine's rapid action on glutamate pathways and its potential benefits in complex psychiatric profiles where traditional treatments like electroconvulsive therapy often fail. A proposed staging model for suicidal behavior management underscores the importance of early intervention with non-classical treatments in high-risk cases.

Conclusion: Intravenous ketamine offers a promising therapeutic option for patients with severe suicidality and comorbidities, warranting further research on its long-term efficacy and safety.