Can Ketamine-Assisted Therapy Help With Suicidal Thoughts?

⚠️ 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.

When Depression Hits Like a Giant Wave: What's Going On and How to Come Up Again

You Didn't See It Coming

Maybe you woke up one morning and immediately knew the depression was back. Or maybe it crept in so slowly that by the time you noticed, you were already under. Either way, depression can arrive like a giant wave — and once it hits, it can knock you so far down that getting back up feels nearly impossible.

If you're reading this from that place right now, I want you to know something first: you are not broken and there is hope. This is an illness. It often is cyclical. It’s not a character flaw. It is not weakness.

So let's talk about what's actually happening — and what you can do about it.

What Depression Actually Does to Your Brain and Body

Depression isn't just sadness. That's one of the biggest misunderstandings about it.

When a depressive episode hits, your brain chemistry is genuinely disrupted. Key neurotransmitters — serotonin, dopamine, and norepinephrine — are out of balance. This affects everything: your mood, your energy, your sleep, your ability to concentrate, and even your physical body.

Here's what that can look and feel like:

• A heaviness in your body that no amount of sleep seems to fix

• The inability to feel pleasure in things that used to bring you joy — this is called anhedonia, and it's one of depression's most disorienting symptoms

• Slowed thinking — like your brain is moving through mud

• Negative thoughts that feel completely true, even when they aren't — one of depression's cruelest tricks is making its lies feel like facts

• Irritability or anger that feels out of proportion— depression doesn't always look like sadness; for many people it shows up as a short fuse, frustration, or a simmering rage that's hard to explain

• Physical symptoms — headaches, digestive issues, aching muscles

• Withdrawing from people, even people you love

This is your brain short circuiting.

Why Pulling Yourself Out Feels So Hard

Here's the cruel irony of depression: the very things that would help you feel better are the things that feel most impossible to do, or that you are resistant to do.

Exercise helps — but you can barely get off the couch. Connecting with someone helps — but you feel like a burden. Getting outside helps — but the weight of it all is too much.

This is why "just push through it" or "think positive" advice is so frustrating and unhelpful. Depression physically changes how your brain functions. It's not about motivation or mindset. It's biology.

And knowing why it's so hard can actually be the first step toward being gentler with yourself — which, it turns out, is where healing often begins.

Why Depression Often Comes Back — and What Sets It Off

For many people, depression isn't a one-time event. It's cyclical. It comes, it lifts, and then — sometimes out of nowhere, sometimes very predictably — it comes back again.

This is one of the hardest things to sit with: you've been through this before. You know the way out. And yet here you are again. The voice that says I'll never escape this — that's the illness talking, not reality. That can bring its own layer of grief, shame, and exhaustion on top of the depression itself.

But understanding why it cycles can make the return feel less like a personal failure and more like what it actually is — a predictable pattern of an illness that has triggers.

Stress: A Very Common igniter

Stress and depression have a well-documented relationship. Chronic stress raises cortisol — your body's primary stress hormone — and over time, elevated cortisol can disrupt the very neurotransmitters that regulate your mood. When life piles on — work pressure, relationship strain, financial worry, loss — your brain's resilience gets worn thin, and a depressive episode can follow.

The tricky part is that stress can start to feel like I normal. We may miss the signs that we’re getting really stress. We often adapt, push through, cope, keep going. Until we can't.

For Women: Hormones Are a Real Factor

If you're a woman and you've noticed your depression and mood shifts tend to spike at certain times — around your period, after pregnancy, during perimenopause — you are not imagining things.

Estrogen and progesterone directly influence serotonin levels in the brain. When these hormones fluctuate — which they do considerably across the menstrual cycle, postpartum, and through the transition into menopause — so can your mood. This is why conditions like PMDD (premenstrual dysphoric disorder) and postpartum depression exist, and why some women find their depressive episodes track closely with hormonal shifts.

This doesn't mean your depression is "just hormones" or somehow less real. It means your brain is particularly sensitive to these chemical changes — and that's important information for how you and your treatment team approach your care.

"Faking It Till You Make It" Has a Limit

Ah the crash or the collapse that comes after a long stretch of holding it together.

Many people with depression become remarkably skilled at functioning on the surface — showing up, getting through the day, keeping up appearances — while quietly running on empty underneath. There's even a name for it: high-functioning depression. You look fine. You may even feel okay-ish some of the time. But you're spending reserves you're not replenishing.

Eventually, the mask gets too heavy. The effort of maintaining that gap between how you feel and how you present is exhausting in its own right. And when the crash comes, it can feel sudden and confusing — I was doing so well — even though the buildup had been happening for a long time.

This is one of the reasons early support matters so much. You don't have to wait until you're flattened to ask for help.

The gut-brain connection is real

Your digestive system and your brain are in constant conversation. Researchers call it the gut-brain axis, and it's one of the more fascinating — and clinically relevant — areas of mental health research right now.

Here's why it matters for depression. Your gut is home to trillions of microorganisms — bacteria, fungi, and other microbes — that collectively make up your gut microbiome. This ecosystem does far more than digest your food. It helps produce neurotransmitters, including roughly 90% of the body's serotonin. It regulates your immune system. And when it's out of balance — through poor diet, chronic stress, illness, antibiotics, or disrupted sleep — the effects can ripple all the way to your mood.

When the gut microbiome is disrupted, it can trigger inflammation — not just in your body, but in your brain. Neuroinflammation is now recognized as a significant contributor to depression. Inflammatory signals can interfere with the very neurotransmitter systems that regulate mood, and research consistently shows that people experiencing depression often have elevated inflammatory markers in their blood.

Think of it this way: chronic stress depletes the gut. A depleted gut ramps up inflammation. Inflammation disrupts brain chemistry. Brain chemistry disruption deepens depression. And depression, in turn, disrupts sleep, appetite, and stress response — which further impacts the gut. It's a cycle that feeds itself, which is part of why depression can be so hard to shake without support.

This doesn't mean you need to overhaul your entire diet or take a shopping cart full of supplements. But it does mean that things like eating more whole foods, reducing ultra-processed foods, getting adequate sleep, and managing stress aren't just "wellness tips" — they're actions that directly affect the biological environment in which your mood lives.

This is also why a whole-person approach to treating depression matters. What you eat, how you sleep, how much you move, and how much chronic stress you're carrying are all part of the picture — not separate from your mental health, but deeply intertwined with it.

What You Can Actually Do—Even When Everything Feels Impossible

I want to offer something practical here — not a 10-step list that feels overwhelming, but a few real, manageable places to start.

1. Start Smaller Than You Think You Should

When you're depressed, a goal like "go to the gym" can feel as daunting as climbing Everest. So we shrink it. Not to the gym — to finding a system to set your gym clothes out.

This isn't giving up. This is working with your brain instead of against it. Small actions create small wins. Small wins create momentum. And momentum is everything when you're fighting your way back up.

2. start a routine

Depression disrupts your biological rhythms — your sleep-wake cycle, your appetite, your energy patterns. One of the most stabilizing things you can do is keep a basic structure to your day, even if it's minimal.

Wake up at the same time (easier said than done). Eat one thing a day that is nutritious. Step outside, even briefly. Drink your water. These anchors help regulate your nervous system in ways that go deeper than they might appear.

3. Don't Isolate, Even When You Want To

Depression will tell you that no one wants to hear from you, that you're too much, that you should handle this alone. This is the illness talking — not the truth.

You don't have to have a deep conversation. You could start by exchanging a couple words to a cashier (yeah you’ll have to find a non self-checkout). Even small contact — a text, a walk with someone, sitting near another human being — can interrupt the cycle of isolation that depression feeds on.

One of the most powerful forms of connection when you're depressed is being around people who truly get it — not because they read about it, but because they've lived it. That's exactly what peer support groups offer.

DBSA (Depression and Bipolar Support Alliance) runs free online and in-person support groups specifically for people living with depression and bipolar disorder. The groups are peer-led, meaning the person facilitating the meeting has their own lived experience with a mood disorder. There's no pressure to talk. You can just listen. And something shifts when you hear someone else describe exactly what you've been feeling — the isolation lifts a little, and so does the shame. You might be nervous at first to join. That’s ok, just know you are doing this so you don’t have to feel so bad.

DBSA has over 450 groups across the country, and their online groups are available to anyone, anywhere. You can find a group at dbsalliance.org/support.

4. Notice the Narrative Your Brain is Spinning

Depression is a story-teller, and it is not a reliable one. It tells you nothing will ever change, that this is just who you are, that you're a burden to everyone around you and you are a horrible friend, parent, etc.. It speaks with total confidence. It feels true in your bones.

But here's something worth writing on a sticky note and putting somewhere you'll see it: don't believe everything you think. And the corollary to that: feelings aren't facts. Feeling worthless doesn't make you worthless. Feeling like things will never get better doesn't mean they won't. Feeling like a burden doesn't mean you are one.

This is the illness talking. Depression distorts perception — that's not a metaphor, it's neuroscience. A depressed brain is literally filtering reality through a negative lens.

When you notice these thoughts, try labeling them: "That's a depression thought." You don't have to argue with them or replace them with forced positivity. Just creating a tiny bit of distance between you and the thought can help. You are not your depression, and your depression is not the truth.

5. Get Support — Professional Support

I want to be direct here: depression responds very well to treatment. Therapy, and sometimes medication, can genuinely change the trajectory of what you're experiencing.

This isn't a sign that you've failed. It's a sign that you're taking your brain as seriously as you'd take any other organ in your body. You wouldn't try to muscle through a broken leg. Depression deserves the same care.

Free Resources — You Don't Have to Figure This Out Alone

Support doesn't have to start with therapy. Here are a few free places to turn when you need connection or information right now:

• DBSA Online Support Groups — Free peer-led groups for depression and bipolar disorder, available online from anywhere. dbsalliance.org/support

• DBSA In-Person Chapter Groups — Find a local group near you. dbsalliance.org/chapters

• 988 Suicide & Crisis Lifeline — Call or text 988 any time, day or night, if you're in crisis or just need to talk.

• Crisis Text Line — Text HOME to 741741 to connect with a trained crisis counselor by text.What

What About When It's Really Bad?

If your depression has brought you to a place where you're having thoughts of suicide or self-harm, please reach out for help right now.

You can call or text 988 (the Suicide and Crisis Lifeline) any time, day or night.

This kind of darkness can feel permanent — but it isn't. And you don't have to face it alone.

The Wave Will Not Last Forever

Here's what I know after 15 years of working with people in the depths of depression: the wave does not last forever.

It feels permanent. Depression makes everything feel permanent. But people do come back up. With the right support, the right tools, and time — the weight lifts. Life becomes livable again. Sometimes even more than that.

You deserve support right now, not once you've "earned" it by trying hard enough on your own.

If you're in Colorado or California and you're ready to explore what that support could look like, I'd love to connect. You can book a free 15-minute consultation here.

You don't have to keep treading water alone.

Amanda Rebel, LMFT, is a Denver-based therapist specializing in bipolar disorder, depression, and anxiety. She sees clients in Colorado and California via telehealth.

The Benefits of Ketamine Assisted Therapy for Depression

Depression can be an all-consuming mental health condition. You might be more familiar with its traditional treatment methods. Most people respond well to prescription antidepressants, therapy, and lifestyle changes. However, some struggle with treatment-resistant depression, meaning the go-to options for healing depression don’t work for them. In recent years, ketamine-assisted psychotherapy (KAP) has become a viable option for those who need less conventional treatments for their depression. Here’s how it works and how you can benefit.

How Ketamine Changes the Brain

Ketamine, originally developed as an anesthetic in the 1960s, has gained attention in the psychiatric field for its antidepressant effects. Ketamine works by modulating the brain’s glutamate system, a neurotransmitter involved in mood regulation, cognition, and neural plasticity. By blocking NMDA (N-methyl-D-aspartate) receptors, ketamine helps release more glutamate, which in turn stimulates the growth of new neural connections. This neuroplasticity is thought to be behind ketamine’s rapid antidepressant effects. It helps “reset” the brain and form new neural pathways that may have been lost during long-term depression.

What Happens in a KAP Session?

During a KAP session, patients are typically given a low dose of ketamine under the careful supervision of healthcare providers. It can be ingested through a nasal spray, oral tablet, or IV infusion. Since the dissociative effects of ketamine can lead to altered states of consciousness, the patient should feel more open to introspection and processing their feelings. After the infusion, a trained therapist guides the patient through their ketamine experience by helping them navigate their thoughts and emotions. This is called integration—the therapist opens a dialogue to make sense of the patient’s insights that arose during their ketamine infusion session. They can then go on to integrate these discoveries into their daily life through better communication, healthier coping skills, and a stronger sense of self.

Benefits of KAP

• It strengthens neural pathways

The neuroplastic effects of ketamine help the brain form new connections. This builds resilience against future depressive episodes (and may stop their recurrence altogether). The therapy part of KAP also helps a person understand their emotions, develop healthy coping skills, and process negative experiences. These all give the brain a greater ability to deal with life’s stressors and stay mentally healthy.

• It works quickly

Compared to other medications and therapies, KAP can alleviate symptoms of depression quite fast. Many patients report feeling relief within a few hours rather than a few weeks or months. For those who have felt trapped by their depression, this fast-acting treatment can be life-changing.

• It reduces suicidal ideation

For those at a high risk of suicide, ketamine can be a great treatment option. Some antidepressants have suicidal ideation as a potential side effect (and can take weeks to begin working). Since ketamine works quickly and doesn’t have the potential for suicidal side effects, ketamine therapy can be lifesaving.

• It encourages big breakthroughs

Some people may take months or years to work up to certain topics during traditional therapy. However, the ketamine-induced altered state of consciousness can help a person access and process feelings and memories that may be difficult to deal with in a typical therapeutic setting.

Potential Drawbacks

While KAP has many benefits, it’s important to recognize that it’s not a one-size-fits-all solution. Ketamine does have side effects and potential drug interactions, so it may not work for people on certain medications. Also, it should only be administered by qualified professionals in a controlled setting, since ketamine has the potential for misuse and addiction.

Are you living with treatment-resistant depression?

If you’re one of the many people who haven’t found the right treatment for your depression, you still have options. To try KAP, talk to a licensed therapist trained in ketamine therapy. Together, you can discuss a treatment plan and determine whether KAP is right for you.

To find out more about the benefits of ketamine-assisted psychotherapy for those with depression, please reach out to me.