Use of Ketamine in the Management of Acute Self-Harm Crisis: A Case Report

Abstract

Intentional self-harm (ISH) is a significant public health concern, especially in young adults, and is frequently associated with depressive disorders.[1] While medical stabilization is the first priority, timely Psychiatric care is critical for the prevention of recurrence. Low-dose ketamine has been known to produce rapid antidepressant effects, including reduction of suicidal ideation. This report is of a patient already on treatment for Moderate Depressive Episode, who presented with an acute suicidal crisis after ingesting approximately 30 tablets of Clonazepam following a familial conflict. After initial emergency medical care, in view of persistent suicidal ideation, a protocol of eight sessions of slow intravenous ketamine infusions (0.5 mg/kg) was initiated at a frequency of two sessions per week. Within 24 hours, there was a clinically meaningful reduction in suicidal ideation. Ongoing treatment and psychotherapy were continued and there was a sustained improvement at six-week follow-up. Ketamine may be a useful rapid-acting adjunct for the rapid reduction of suicidal ideation in treatment-resistant depression, offering a bridge to ongoing treatment.