Intravenous Ketamine for Acute Suicidal Crisis and Psychiatric Hospital Length of Stay

This randomized, double-blind, active placebo-controlled superiority trial will evaluate whether intravenous esketamine reduces time to psychiatric hospital discharge in adults hospitalized because of acute suicide risk. A total of 106 participants will be randomized in a 1:1 ratio to receive intravenous esketamine or midazolam as an active placebo. Participants assigned to esketamine will receive eight 40-minute intravenous infusions at a dose of 0.5 mg/kg administered twice weekly. The primary outcome is time from the first study infusion to psychiatric hospital discharge. Secondary outcomes include suicidal ideation and behavior, depressive symptoms, psychological pain, hopelessness, global clinical improvement, safety, tolerability, dissociative symptoms, and healthcare costs. Exploratory analyses will investigate peripheral inflammatory markers, BDNF, and polygenic risk scores as potential predictors or mediators of treatment response. Clinical follow-up will continue through Week 12.