A New Path Forward: Ketamine as a Safer, Faster Option for Suicidal Depression

If you or someone you love has struggled with depression that doesn’t seem to lift—especially if suicidal thoughts are present—you’ve likely encountered the same dilemma patients have faced for decades: “What happens when nothing works?”

For a long time, the answer was electroconvulsive therapy (ECT). It’s effective. It’s been a go-to for decades. But it comes with a steep price: short-term memory loss, confusion, cognitive fog, and a heavy stigma that still lingers in both the medical community and pop culture.

Now, doctors like Dr. Brian Barnett at Cleveland Clinic are asking a new question: “Can IV ketamine offer similar relief—faster, safer, and without the cognitive cost?”

The Challenge of Suicidal Depression

Most inpatient psychiatric units follow the same basic script:

• Admit the patient.

• Tweak their medications.

• Wait and monitor.

• Discharge after 3–5 days if the suicidal thoughts subside.

But waiting isn’t the same as treating. And in those crucial first days, the risk of harm doesn’t vanish just because someone’s in a hospital bed.

What if instead of just waiting, we had a tool that could rapidly reduce suicidal ideation and restore a sense of mental stability?

That’s the goal of the national trial Dr. Barnett is leading. Funded by the Patient-Centered Outcomes Research Institute, the study will follow 1,500 patients the next five years across major institutions like Johns Hopkins, Mount Sinai, Baylor, and Cleveland Clinic.

Ketamine vs. ECT: What the Trial Is Testing

Participants are randomly assigned to one of two treatments:

• 12 sessions of electroconvulsive therapy

• 8 IV ketamine infusions over 4 weeks (0.5mg/kg body weight)

They’re monitored for six months, with follow-ups at 1, 3, and 6 months post-treatment. Importantly, participants also have access to Collaborative Assessment and Management of Suicidality (CAMS) therapy—a proven, supportive approach to ongoing suicidal ideation.

Unlike traditional clinical trials that exclude all but the healthiest candidates, this is a real-world trial. Patients with co-occurring conditions are welcome—except those with psychosis or serious heart issues.

In short: this trial reflects the patients we actually see in clinic and in hospitals.

What We Already Know from the ELEKT-D Study

While Dr. Barnett’s trial is ongoing, a separate study already points to the cognitive advantage of ketamine.

In the ELEKT-D trial (2017–2022), researchers compared ECT with IV ketamine in patients with treatment-resistant depression. Here’s what they found:

• Both treatments were effective in reducing depression symptoms.

• Ketamine patients reported improved memory and daily functioning.

• ECT patients experienced temporary cognitive decline, especially in memory and executive function.

This matters deeply for patients who want to feel like themselves again—not just “better,” but clear-minded, focused, able to return to work and family life without confusion or fog.

The Problem With ECT (Even When It Works)

Dr. Barnett puts it plainly: “You’d think it’d be painful or we’re doing it without anesthesia, but it’s actually a very routine procedure today.”

It is safe. It is administered under general anesthesia. But still, more than half of ECT patients experience temporary memory loss, and that’s often enough to make people hesitate.

Beyond that? Some patients can’t safely undergo anesthesia, making ECT an inaccessible option entirely.

This is where IV ketamine shines. The side effects are short-lived—typically ending once the infusion is over—and there’s no cognitive decline. For many patients, mental clarity actually improves alongside mood.

Why This Trial Matters

Like so much with ketamine, this trial is a hope story.

Doctors across the country are recognizing that suicidal depression needs more than just “wait and see.” It needs fast, safe intervention—one that reflects the complex needs of real patients, not just the ones who fit neatly into a chart.

If this trial confirms what early data suggests, ketamine could become the standard of care for patients in acute crisis—offering a non-invasive, rapid, and cognitively safe path toward healing.

What It Means for You

If you’ve tried multiple antidepressants without success…

If you’re tired of hearing “just wait a few more weeks”…

If you or a loved one is struggling with suicidal thoughts…

You are not alone. And you are not out of options.

IV ketamine may be a safer, faster way forward. And at New Pathways, we walk this path with you—no judgment, no pressure, just the science, the care, and the time it takes to heal.