Ketamine has been proposed as a possible treatment for people with borderline personality disorder who also struggle with depression and suicidal thinking, but a new systematic review concludes that the existing evidence is not yet strong enough to say whether the drug actually works for this population. The review, published in the journal Borderline Personality Disorder and Emotion Dysregulation, examined intravenous and intranasal racemic ketamine in adults formally diagnosed with BPD or with elevated borderline features.
The research team, led by Annie Xiong and Sebastian Kolde with senior author Paul S. Links, searched MEDLINE, Embase and CENTRAL for studies published up to February 2026. Five studies met their inclusion criteria: two randomized controlled trials and three cohort studies. Four of the studies evaluated intravenous ketamine, while one evaluated the intranasal racemic formulation. In total, 81 participants identified as having BPD received ketamine across four studies, and one additional study included 31 ketamine-treated participants with elevated borderline features who did not have a confirmed BPD diagnosis.
The review’s primary outcomes were depression, BPD symptoms and suicidality, with adverse effects of treatment assessed as a secondary outcome. This focus reflects an important clinical gap. According to the review’s background, psychotherapy is the standard treatment for borderline personality disorder, but no pharmacological medications are approved to treat the condition. Many individuals with BPD also experience depression and suicidal ideation, and some ketamine formulations have already been approved for treatment-resistant depression and severe suicidal ideation, making the drug an obvious candidate for study in this population.
On the question of safety, the review found that ketamine appeared to be generally well tolerated over short follow-up periods in supervised settings, although transient side effects, including dissociation, were reported. The authors stress that this observation comes from small studies with limited monitoring windows, so it cannot be extended to long-term or unsupervised use.
Several of the reviewed studies reported reductions in depressive symptoms or suicidal ideation following ketamine treatment. However, the review authors caution that most of these studies were not designed or adequately powered to evaluate efficacy specifically in BPD. In other words, the encouraging signals about depression and suicidality cannot be confidently attributed to benefits for people with borderline pathology, because the trials were not built to answer that question.
The comparative picture was even less clear. Findings comparing participants with and without borderline pathology were inconsistent and did not establish equivalent treatment response between the two groups. Evidence regarding improvement in BPD symptoms themselves was described as sparse, meaning that the core question of whether ketamine relieves borderline personality disorder symptoms remains essentially unanswered.
A major obstacle to drawing conclusions was heterogeneity. The five studies differed substantially in design, method of BPD ascertainment, ketamine protocol, comparator and outcome measurement. This variation makes it difficult to pool findings or to generalize from one study to the next, a limitation the authors highlight alongside small samples, exploratory or retrospective analyses, and short follow-up periods.
The review’s conclusion is deliberately measured: the current evidence is insufficient to determine whether ketamine has a clinically meaningful role in treating depression, BPD symptoms and suicidality in patients with BPD, but further study appears warranted. The authors state that ketamine treatment specifically targeting BPD should be considered investigational, and they call for adequately powered, BPD-specific randomized trials with standardized outcomes and longer follow-up before any conclusions about efficacy, safety or clinical implementation can be made. Until such trials are completed, the review suggests that enthusiasm for ketamine in this population should remain tempered by the quality of the evidence behind it.
Subject of Research: A systematic review of intravenous and intranasal ketamine for depression, borderline personality disorder symptoms and suicidality in adults with BPD.
Article Title: Intravenous and intranasal ketamine for borderline personality disorder to treat comorbid depression, BPD symptoms and suicidality: a systematic review
Article References: Xiong, A., Kolde, S., & Links, P. S. (2026). Intravenous and intranasal ketamine for borderline personality disorder to treat comorbid depression, BPD symptoms and suicidality: a systematic review. Borderline Personality Disorder and Emotion Dysregulation. https://doi.org/10.1186/s40479-026-00377-9
Image Credits: AI Generated
DOI: 10.1186/s40479-026-00377-9
Keywords: ketamine, borderline personality disorder, depression, suicidality, systematic review, intravenous ketamine, intranasal ketamine, dissociation, randomized controlled trials, psychiatry, treatment-resistant depression, Intravenous
News Source: Glenn Wilkins. (October 28, 2026). Ketamine for borderline personality disorder shows promise but evidence remains insufficient, review finds. Scienmag.
