Psychopharmacological Agents and Suicide Risk Reduction: Ketamine and Other Approaches

Introduction

Suicide is a major global public health problem and was already the leading cause of injury mortality in the USA at the time of this review. Most people who die by suicide have a history of mental illness, yet the literature has been dominated by epidemiology and risk-factor identification rather than evidence-based treatment trials. Psychological interventions such as cognitive behavioural therapy and dialectical behaviour therapy have growing evidence in specific subgroups, but pharmacological approaches primarily address the underlying psychiatric disorder rather than acute suicidal crises, and no medications had been proven efficacious specifically for treating acute suicidal episodes. This article sets out to review somatic (biological) treatments for suicidality with particular emphasis on ketamine. The authors summarise the clinical evidence for agents historically linked to reduced suicide risk (notably clozapine and lithium), outline ketamine’s pharmacology, and review emerging clinical and mechanistic data suggesting a rapid anti‑suicidal effect of ketamine among patients with depression and suicidal ideation. The review aims to place ketamine’s findings in context and to identify limitations and research needs for translating these observations into clinical practice.