⚠️ If you or someone you know is in crisis right now: Call or text 988 (Suicide & Crisis Lifeline) | Text HOME to 741741 (Crisis Text Line) | Call 911 or go to your nearest emergency room. You don't have to be at the very edge to reach out. If the thoughts are loud, that's enough.
Suicidal thoughts, or ideations, are far more common than most people realize — and far more common than most people talk about. Research shows that nearly half of people living with bipolar disorder experience suicidal ideation in any given year, and rates among those with depression are similarly high. ⁵ If you've had these thoughts, you are not alone, and things can get better. You are living with an illness that, at its worst, turns the mind against itself.
This post is about something that's changing the way we treat suicidal ideation: ketamine-assisted therapy (KAP). Whether you're navigating this yourself or reading on behalf of someone you love, the research is genuinely remarkable.
First: What Is Suicidal Ideation?
Suicidal ideation is a broad term. It covers a wide range of experiences:
Passive ideation — thoughts like I wish I wasn’t here or everyone would be better off without me
Active ideation — more specific thoughts about plans or acting on those feelings
Both are serious. Both deserve care. And both have been studied in relation to ketamine with genuinely encouraging results.
What Is Ketamine-Assisted Therapy?
Ketamine is a medication that has been used safely in medical settings for over 50 years — originally as an anesthetic. In recent years, researchers discovered that, in low, controlled doses, it has powerful effects on depression and suicidal thinking.
Ketamine-assisted therapy (KAP) combines a supervised ketamine session with psychotherapy. The ketamine is administered in a safe, clinical setting. A therapist works with you before, during, and after the experience to help you process what comes up and turn insight into lasting change.
It's not about losing control. It's a supported, intentional experience — designed to help your brain do something it may have been struggling to do on its own.
What the Research Says
Here's where things get remarkable.
Most antidepressants take four to six weeks to show any effect. Ketamine can reduce suicidal thinking within hours.
A 2025 real-world study of 96 patients with treatment-resistant depression found a significant reduction in suicidality after IV ketamine — what's striking is that ketamine appeared to reduce suicidal thoughts directly, not simply as a byproduct of improving depression. Even in patients whose depression didn't fully lift, the suicidal thinking still quieted.
A 2024 study of over 500,000 patients found that people prescribed ketamine had significantly lower rates of suicidal ideation compared to those on other antidepressants — both in the short term and up to nine months later. ²
A 2026 systematic review and meta-analysis of 21 studies (927 participants) confirmed that ketamine reliably reduces suicidal ideation in high-risk populations. ³
The pattern across the research is consistent: ketamine works fast, and it works on suicidal thinking specifically.
Your Brain Can Change: The Neuroplasticity Connection
It's not just about a medication doing something to you. It's about what your brain is capable of.
Depression isn't just a mood. It's a brain state. Chronic depression and prolonged stress can actually shrink the connections between brain cells — especially in the areas that regulate mood, hope, and how we see the future. Over time, the brain can get stuck in grooves: the same dark thoughts, the same hopeless loops, the same inability to imagine things being different.
This is where neuroplasticity comes in.
Neuroplasticity is the brain's ability to form new connections, rewire old patterns, and rebuild pathways that have been worn down. Think of it like this: depression carves deep ruts in the road, and your thoughts just keep falling into them — no matter how much you try to steer somewhere else.
Ketamine interrupts that pattern at the biological level.
Research shows that ketamine rapidly increases a protein called BDNF (brain-derived neurotrophic factor) — essentially a fertilizer for brain cells. It triggers the growth of new synaptic connections, particularly in the prefrontal cortex: the part of the brain responsible for emotional regulation, perspective-taking, and the ability to imagine a future. ⁴
These new connections can begin forming within hours of a ketamine session.
This is why people often describe the days and weeks following KAP as a window — a period when things that felt impossible to think or feel differently about suddenly become more reachable. The rigid, tunnel-vision thinking that often accompanies suicidal ideation starts to loosen.
Ketamine opens the window. Therapy helps you climb through it.
The neuroplasticity that ketamine creates makes the brain more receptive to new patterns, new narratives about yourself, and new ways of relating to pain. That's why the therapy component isn't optional — it's what helps make the change stick.
Why This Is Different From Other Treatments
Standard antidepressants mainly target serotonin, dopamine, or norepinephrine. Ketamine works on an entirely different system: the glutamate pathway — the brain's main excitatory system, deeply involved in mood regulation and neural communication.
This is part of why it can help people who haven't responded to multiple other medications. It's not doing the same thing over and over. It's doing something different.
What a KAP Session Actually Looks Like
A few things worth knowing if you're curious:
My sessions are conducted in a calm, safe office setting
You are monitored throughout the experience
Many people feel a dreamy, slightly altered sense of perception — some describe it as floating, or as a loosening of the grip that their thoughts normally have
Sessions are followed by integration therapy — time to process and make meaning of what came up
A series of sessions is typically recommended, not just one
The experience varies from person to person.
Is It Right for You?
KAP may be worth exploring if:
You've tried multiple antidepressants without adequate relief
You're living with treatment-resistant depression, bipolar 2 depression, or anxiety
Suicidal thoughts have been a persistent part of your experience
You're open to a different kind of therapeutic process
It's not a fit for everyone, and it requires thorough medical screening. But for many people who have been suffering for a long time, it represents something genuinely new: a treatment that can work quickly, targets the pain directly, and gives the brain a real chance to change.
You Are Not Stuck
Depression and anxiety lie. They tell you this is just how things are. That it's been too long. That you've tried too many things. That nothing will work.
The research on ketamine-assisted therapy is one of the most compelling pieces of evidence we have that the brain — your brain — is more capable of change than the thoughts would have you believe.
If you've been living with thoughts about not wanting to be here, please know: that is a symptom, not a truth. And there are treatments now that can specifically target that symptom, sometimes within hours.
You deserve to find out what that feels like.
Ready to Learn More?
I offer ketamine-assisted therapy in Colorado and California. If you're curious whether KAP might be right for you, I'd love to talk. Contact me here to schedule a free 15-minute consultation.
If you or someone you know is struggling with suicidal thoughts:
📞 988 Suicide & Crisis Lifeline — Call or text 988
💬 Crisis Text Line — Text HOME to 741741
🚨 Emergency — Call 911 or go to your nearest emergency room
You don't have to face this alone.
References
¹ Chen-Li, D.C.J., Mansur, R.B., Di Vincenzo, J.D., et al. (2025). Effect of intravenous ketamine on suicidality in adults with treatment-resistant depression: A real world effectiveness study. Psychiatry Research, 343, 116282. https://doi.org/10.1016/j.psychres.2024.116282
² Pan, Y., Gorenflo, M.P., Davis, P.B., Kaelber, D.C., De Luca, S., & Xu, R. (2024). Suicidal ideation following ketamine prescription in patients with recurrent major depressive disorder: A nation-wide cohort study. Translational Psychiatry, 14(1), 327. https://doi.org/10.1038/s41398-024-03033-4
³ Tang, W., Jiang, W.W., Que, W.Q., Zhang, W.Q., Chen, H.L., & Zhou, L.J. (2026). Ketamine treatment alleviates suicide ideation in high-risk populations: a systematic review and meta-analysis. Epidemiology and Psychiatric Sciences. https://doi.org/10.1017/S2045796025100371
⁴ Duman, R.S., & Aghajanian, G.K. (2012). Synaptic dysfunction in depression: Potential therapeutic targets. Science, 338(6103), 68–72. https://doi.org/10.1126/science.1222939
⁵ Dome, P., Rihmer, Z., & Gonda, X. (2019). Suicide risk in bipolar disorder: A brief review. Medicina, 55(8), 403. https://doi.org/10.3390/medicina55080403
Amanda Rebel, LMFT, specializes in bipolar disorder, depression, and anxiety. She practices in Denver, CO, and offers online therapy across Colorado and California.