Correction, October 22, 2026: An earlier version of this article said the two Canadian pilots were the first emergency-department trials of ketamine for adolescent suicidal ideation, and that no trial had tested the drug in that setting. A randomized, double-blind, placebo-controlled trial at Rady Children’s Hospital San Diego began enrolling in March 2022, before either Canadian pilot, and was published in July 2026, before this article. It did not find a significant benefit on its primary outcome. The headline, summary and the passages describing the Canadian pilots as the first have been corrected, and a description of the San Diego trial has been added.
A teenager who arrives at an emergency department with suicidal thoughts today has no rapid-acting drug treatment option built specifically for that moment. Adults have more, though less than is often assumed: intravenous ketamine has repeated trial evidence for fast reduction of suicidal ideation, and esketamine is approved, under a monitored REMS protocol, for treating depressive symptoms in adults with major depressive disorder who have acute suicidal ideation or behavior. Its label is explicit that effectiveness in reducing suicidal ideation or behavior itself has not been demonstrated. In the emergency department, the adolescent trials published so far are small and early: two Canadian children’s hospital pilots asking whether it is even feasible to study this properly, and a U.S. trial that tested a low dose against placebo and did not find a significant benefit.
What the trials did
Researchers at BC Children’s Hospital ran a triple-blinded, three-arm pilot comparing IV ketamine against midazolam and against plain saline in patients aged 10 to 17 who presented to the pediatric emergency department with suicidal ideation and required hospitalization. The trial stopped early, at 15 participants, for operational and staffing reasons rather than safety ones. A separate single-site pilot at the Children’s Hospital of Eastern Ontario, led there by emergency researcher Maala Bhatt with a first author based at Alberta Children’s Hospital, enrolled 20 medically stable adolescents aged 12 to 17 presenting to the ED with moderate to severe suicidal thoughts and compared a single IV ketamine dose against saline, double-blinded. Neither trial set out to prove ketamine works. Both were explicitly feasibility studies, asking whether enrollment, blinding, and follow-up could be pulled off in this specific population and setting, the necessary step before anyone could run a trial large enough to test efficacy directly.
A third trial had already tested a clinical outcome in the same setting. At Rady Children’s Hospital San Diego, researchers enrolled adolescents aged 12 to 17 with treatment-resistant depression who came to the emergency department with suicidal ideation requiring psychiatric admission, between March 2022 and December 2023, and randomized them to a single low dose of IV ketamine, 0.2 milligrams per kilogram, or saline, double-blinded. Its primary outcome was the share of patients whose depression and suicidal-ideation scores fell by at least half within three hours. Among the 29 analyzed, that share did not differ significantly between ketamine and placebo, and signs of dissociation were far more common with ketamine, 60 percent against 7 percent, none lasting past the one-hour observation period. The trial was published in the Western Journal of Emergency Medicine on July 28. Its authors describe it as demonstrating feasibility and call for larger studies of dosing and delivery. The dose was lower than the 0.5 milligrams per kilogram both Canadian pilots used.
Why feasibility work matters more than it sounds like it should
A September commentary in the Canadian Journal of Emergency Medicine, written by Lindsay Maguire alongside Manish Jha and Martin Than, argues that pilot work like this matters beyond its own results. In adults, IV ketamine’s reduction in suicidal ideation appears within a day and, in pooled analyses, holds for roughly 72 hours to a week; the commentary notes the effect may persist for weeks in some responders, long enough to bridge a patient to outpatient care. Adolescents are not untouched by this research. A 147-patient Janssen trial tested intranasal esketamine against an active comparator in hospitalized adolescents at imminent risk for suicide, improving depression scores at 24 hours without separating from its comparator on suicidality itself, and a small Yale crossover trial tested IV ketamine in adolescents with treatment-resistant depression. What neither the Janssen nor the Yale trial did was test the drug in the emergency department itself, the setting where a suicidal teenager shows up first. Dosing, dissociation monitoring, and parental consent all raise distinct questions in a pediatric emergency setting that adult protocols were never built to answer, and a formal path toward any pediatric-specific approval or labeling would need dedicated trial data generated in this population and setting, not an assumption that adult evidence will translate cleanly.
What the two pilots can’t tell you yet
Both pilots measured feasibility, not whether ketamine reduces adolescent suicidal ideation more than a comparator does. Secondary symptom data exists in both, and in the Ottawa trial the difference on a suicidal-ideation scale at 40 minutes did not reach statistical significance, in a study of 20 people never sized to detect one. Feasibility pilots are explicitly underpowered for the efficacy question the field needs answered, and neither study was designed to answer it. That is not a flaw unique to these two trials; it is the normal shape of early work in a setting where trials are hard to run.
What comes after a feasibility pilot, including one that stopped early
A feasibility pilot’s output is a blueprint, and these two returned different pages of it. The Ottawa pilot enrolled its 20 adolescents and completed, evidence that recruitment, blinding, and follow-up can work in an ED crisis setting. The BC pilot stopped at 15 of its planned participants because of staffing and operational limits, which is feasibility data of a harder kind: it marks exactly where an emergency-department trial of this population breaks under real conditions. Two independent teams, two designs, one completed and one halted, leaves the next stage of research with both a working template and a map of the failure mode. The San Diego result adds a caution about dose: at 0.2 milligrams per kilogram, a randomized comparison in this setting did not separate from placebo. Whether any of these groups, or a new one, runs the properly powered efficacy trial next is the thing to watch, not anything in these pilots themselves.