Purpose: To assess whether esketamine can be utilized short-term while waiting for a new oral antidepressant to reach therapeutic level in patients admitted for treatment resistant depression and suicidal ideation.

Method: A PubMed search was conducted using the advanced search builder, and the terms “esketamine” and “suicide” were entered with the “5 years” filter. This resulted in 90 articles. Of these, only three articles were randomized controlled trials that were considered relevant for this systematic review.

Results: Intranasal esketamine was effective for the rapid reduction of depressive symptoms and suicidal ideation and continued to be effective for depression past the 24-hour endpoint; however, the data does not indicate significant improvement with suicidal ideation past the same 24-hour endpoint.

Conclusion: Intranasal esketamine could potentially fulfill the need for rapidly reducing depression and short-term suicidal ideation de-escalation in mental health crises, but additional studies need to be completed before it can be concluded that intranasal esketamine is effective for continuing to minimize suicidal ideation during the weeks required for standard of care oral antidepressants to become optimal.