SynthesisBrain and behavior2026
Comparative Efficacy and Safety of Ketamine Versus Midazolam for Suicidality: A GRADE-Assessed Systematic Review and Meta-Analysis of Randomized Controlled Trials.
Synthesis in Brain and behavior, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
2 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Comparative Efficacy and Safety of Ketamine Versus Midazolam for Suicidality: A GRADE-Assessed Systematic Review and Meta-Analysis of Randomized Controlled Trials.Brain and behavior · 2026Pooled it
- Psychedelics in Mental Health: Opportunities and Challenges.Brain and behavior · 2026Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
12 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundAcute suicidality is an emergency psychiatric condition that requires urgent treatment. Traditional treatment approaches, such as antidepressant pharmacotherapy and psychotherapy, take weeks to achieve optimal effectiveness, hence exposing patients in imminent crisis to significant risk. Ketamine is a fast-acting N-methyl-D-aspartate (NMDA) receptor antagonist that has been suggested as a possible treatment option for suicidality. The current meta-analysis aims at comparing the relative efficacy and safety of ketamine with midazolam, an active sedative/anxiolytic comparator used in ketamine trials to support masking/blinding and control nonspecific acute effects, for reducing suicidal ideation and co-occurring depression severity.
methodsThe systematic search was done on PubMed, Embase, and Cochrane Central databases by July 2025. Randomized controlled trials (RCTs) that involved ketamine and midazolam in adults with acute suicidality were chosen. The major outcomes were the variations in suicidal ideation as assessed by the Montgomery-Åsberg Depression Rating Scale-Suicidal Ideation item (MADRS-SI) and Beck Scale of Suicide Ideation (BSS). Additional outcomes were the severity of depression in general (Montgomery-Åsberg Depression Rating Scale (MADRS) total score) and adverse events. Pooled effects were calculated using a random-effects model.
resultsThis systematic review comprised ten randomized controlled trials (RCTs) with 649 participants. The meta-analysis showed that the administration of ketamine was linked to a considerable decrease in suicidal ideation in comparison to midazolam with mean differences of -1.23 points on the Montgomery-Åsberg Depression Rating Scale (MADRS-SI; 95% confidence interval (CI) -2.14 to -0.32) and -4.30 points on the Beck Scale for Suicide Ideation (BSS; 95% CI -8.01 to -0.59). Ketamine was also associated with reduced severity of depressive symptoms compared to midazolam, with a difference of -6.23 (95% CI -10.37 to -2.08) on the MADRS total score. At the same time, adverse events such as nausea, emotional disturbance, derealization, and dizziness were much more frequent in the ketamine group.
conclusionsKetamine is much more effective than midazolam in the short-term improvement of suicidal ideation and depressive symptoms in adult patients with acute suicidality. Despite the fact that ketamine is linked to increased rates of transient adverse effects, its quick action makes it an especially appealing intervention in emergency psychiatric treatment. Further research is thus needed to clarify the long-term effectiveness of the agent and to optimize the best treatment regimes.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.