Case report of S-ketamine as treatment option for suicidal ideation and treatment-resistant depression in adolescents with early-onset psychosis

Vollständiger Abstract

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Summary Background Depressive symptoms and suicidality are highly prevalent in adolescents with early-onset psychosis (EOP) and often remain refractory to standard treatment. While S‑ketamine is an established treatment for treatment-resistant depression in adults (TRD), its use in primary psychotic disorders remains scarce due to risk of exacerbation of psychotic symptoms. Case presentation We present the case of a 16-year-old male with schizophrenia (ICD-10: F20.9) and chronic suicidality. Despite achieving remission of positive symptoms with amisulpride, severe depressive symptoms including suicidality persisted. Following the initiation of off-label intranasal S‑ketamine (titrated to 84 mg) at age 17 and 11 months, the patient showed a rapid clinical response. The Montgomery–Åsberg Depression Rating Scale (MADRS) score decreased by 50% within 3 weeks, accompanied by a significant reduction in the Positive and Negative Syndrome Scale (PANSS)–positive symptoms subscale score (from 22 to 10) and the PANSS–negative symptoms subscale score (from 33 to 17). Notably, no exacerbation of remitted positive symptoms occurred, and sustained functional recovery was achieved. Conclusion This case suggests that intranasal S‑ketamine may be a safe and effective augmentation strategy for TRD and suicidality in stable adolescent early-onset psychosis, highlighting the need for further research in this high-risk population.