Esketamine plus standard care for adolescents with major depressive disorder and acute suicidal thoughts or behavior
Official title: A Double-blind, Randomized, Psychoactive Placebo-controlled Study to Evaluate the Efficacy and Safety of Intranasal Esketamine 84 mg in Addition to Comprehensive Standard of Care for the Rapid Reduction of the Symptoms of Major Depressive Disorder in Adolescent Participants With Acute Suicidal Ideation or Behavior
Run by Janssen Research & Development, LLC · NCT07227454 · Data updated 2026-11-12
This will test whether adding intranasal esketamine to usual care helps hospitalized adolescents with major depressive disorder and acute suicidal thoughts or behavior feel better faster than a psychoactive placebo plus usual care.
Quick facts
| Phase | Phase 3 |
|---|---|
| Study type | Interventional |
| Ages | 12 Years to 17 Years |
| Sex | All |
| Enrollment | 258 (estimated) |
| Sponsor | Janssen Research & Development, LLC Industry-sponsored |
| Locations | 49 sites (Birmingham, Alabama and 48 other locations) |
| Status | Recruiting |
| Started | January 8, 2026 |
| Main results expected | April 9, 2031 |
| Study ends | September 15, 2031 |
| Registry record updated | November 3, 2026 |
| Trial ID | NCT07227454 on ClinicalTrials.gov |
Is this trial a fit for you?
✓Likely a good fit
Adolescents with DSM-5 major depressive disorder who are hospitalized for acute suicidal ideation or behavior and meet high severity scores (CDRS-R ≥58 and CGI-SS-R ≥4) are the intended participants.
✕Probably not a fit
Patients with diagnoses excluded by the protocol such as bipolar or certain psychotic disorders, or those who are not medically stable or do not require hospitalization, are unlikely to be eligible or to benefit from this study.
A plain-English reading of the study's rules. Only the study team can confirm whether you qualify.
What this trial studies
This Phase 3, randomized, double-blind trial compares intranasal esketamine plus comprehensive standard of care (SoC) versus a psychoactive placebo plus SoC in adolescent participants hospitalized for acute suicidal ideation or behavior. Eligible participants must meet DSM-5 criteria for major depressive disorder and high severity thresholds (CDRS-R ≥58 and CGI-SS-R ≥4) and be medically stable for participation. The psychoactive placebo arm includes an active agent to preserve blinding, and outcomes focus on rapid reduction of depressive symptoms and suicidality after dosing in the inpatient setting. The trial is conducted at multiple U.S. centers and uses standardized rating scales and clinician assessments to measure safety and efficacy.
Why it matters
Potential benefit: If successful, this approach could produce faster reductions in depressive symptoms and suicidal ideation for hospitalized adolescents than standard care alone.
How similar studies have gone: Esketamine has demonstrated rapid antidepressant effects in adults, but controlled Phase 3 evidence specifically in adolescents with acute suicidality is limited.
Who can join: the full rules
Show full inclusion / exclusion criteria
Inclusion Criteria: * Must meet diagnostic and statistical manual of mental disorders (5th edition) (DSM-5) diagnostic criteria for major depressive disorder (MDD) based upon clinical assessment and confirmed by the mini-international neuropsychiatric interview for children and adolescents (MINI-KID) * Must have a clinical global impression - severity of suicidality - revised (CGI-SS-R) score of "Markedly" or greater (that is, greater than or equal to \[\>=\] 4) at both screening and baseline (predose) visits * Must have a children's depression rating scale - revised (CDRS-R) total score \>= 58 at baseline (predose) * In the physician's opinion, acute psychiatric hospitalization is clinically warranted due to subject's acute suicidality * Must be medically stable based on physical examination, medical history, vital signs, and 12-lead electrocardiogram (ECG) performed at screening Exclusion Criteria: * Participant has a current DSM-5 diagnosis of bipolar (or related disorders), intellectual disability, autism spectrum disorder, conduct disorder, oppositional defiant disorder * Participant currently meets DSM-5 criteria for borderline personality disorder * Participant has a current or prior DSM-5 diagnosis of a psychotic disorder, or MDD with psychosis * Participant has a history of seizure disorder * Participant has known allergies, hypersensitivity, intolerance or contraindications to midazolam, esketamine or ketamine, or their excipients
Where it's running
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University of Alabama at Birmingham
Birmingham, Alabama, United States Recruiting -
Yale Child Study Center
New Haven, Connecticut, United States Recruiting -
Children's National Medical Center
Washington D.C., District of Columbia, United States Recruiting -
Peachford Hospital-Atlanta Behavioral Research
Atlanta, Georgia, United States Recruiting -
Endeavor Health Evanston Hospital
Evanston, Illinois, United States Recruiting -
Johns Hopkins University
Baltimore, Maryland, United States Recruiting
Show 43 more locations
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Boston Childrens Hospital
Boston, Massachusetts, United States Recruiting -
Mayo Clinic
Rochester, Minnesota, United States Recruiting -
University of North Carolina at Chapel Hill
Chapel Hill, North Carolina, United States Recruiting -
University of Cincinnati
Cincinnati, Ohio, United States Recruiting -
Bradley Hospital
East Providence, Rhode Island, United States Recruiting -
John S Dunn Behavioral Sciences Center at UTHealth Houston
Houston, Texas, United States Recruiting -
Sociedade Literaria e Caritativa Santo Agostinho Hospital Sao Jose
Criciúma, Brazil Recruiting -
Universidade Federal do Rio Grande do Norte Hospital Universitario Onofre Lopes
Natal, Brazil Recruiting -
Instituto Apice
Salvador, Brazil Recruiting -
Centro Integrado Facili
São Bernardo do Campo, Brazil Recruiting -
Instituto de Pesquisa Pensi Sandra Mutarelli Setubal
São Paulo, Brazil Recruiting -
Hospital Das Clinicas Da Faculdade De Medicina Da USP
São Paulo, Brazil Recruiting -
Vadaskert Gyermek es Ifjusagpszichiatriai Korhaz es Szakambulancia
Budapest, Hungary Recruiting -
Debreceni Egyetem Klinikai Kozpont
Debrecen, Hungary Recruiting -
Petz Aladar Megyei Oktato Korhaz
Győr, Hungary Recruiting -
Szegedi Tudomanyegyetem
Szeged, Hungary Recruiting -
Presidio Ospedaliero Santa Marta e Santa Venera
Acireale, Italy Recruiting -
Azienda Ospedaliera G. Brotzu
Cagliari, Italy Recruiting -
AOU Meyer
Florence, Italy Recruiting -
Azienda Ospedaliera Universitaria Policlinico Riuniti di Foggia
Foggia, Italy Recruiting -
G.Gaslini Institute
Genova, Italy Recruiting -
Ospedale di Merano
Merano, Italy Recruiting -
Azienda Ospedaliera Universitaria Federico II
Naples, Italy Recruiting -
Azienda Ospedaliero Universitaria di Sassari
Sassari, Italy Recruiting -
Spitalul Clinic de Psihiatrie Prof Dr Alexandru Obregia
Bucharest, Romania Recruiting -
Spitalul Clinic de Urgenta pentru Copii Cluj Napoca
Cluj-Napoca, Romania Recruiting -
Spitalul Clinic De Psihiatrie Doctor Gheorghe Preda
Sibiu, Romania Recruiting -
Spitalul Clinic de Urgenta pentru Copii 'Louis Turcanu' Timisoara
Timișoara, Romania Recruiting -
Hosp Univ Vall D Hebron
Barcelona, Spain Recruiting -
Hosp. Clinic de Barcelona
Barcelona, Spain Recruiting -
Hosp. Sant Joan de Deu
Esplugues de Llobregat, Spain Recruiting -
Hosp. Gral. Univ. Gregorio Maranon
Madrid, Spain Recruiting -
Hosp. Univ. La Paz
Madrid, Spain Recruiting -
Fundacio Althaia Xarxa Assistencial Universitaria de Manresa
Manresa, Spain Recruiting -
Hosp. Univ. Central de Asturias
Oviedo, Spain Recruiting -
Clinica Univ. de Navarra
Pamplona, Spain Recruiting -
Hosp.Univ.Parc Tauli
Sabadell, Spain Recruiting -
Hosp. Univ. Marques de Valdecilla
Santander, Spain Recruiting -
Mackay Memorial Hospital Tamsui Branch
New Taipei City, Taiwan Recruiting -
National Taiwan University Hospital
Taipei, Taiwan Recruiting -
Taipei Medical University Hospital
Taipei, Taiwan Recruiting -
Taipei Veterans General Hospital
Taipei, Taiwan Recruiting -
Tri-Service General Hospital
Taipei, Taiwan Recruiting
Study contacts
- Study coordinator: Study Contact
- Email: Participate-In-This-Study1@its.jnj.com
- Phone: 844-434-4210
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How to take part
- Review the eligibility criteria above with your treating physician.
- Check the official listing on ClinicalTrials.gov for the latest contact details and recruitment status.
- Contact the study coordinator or principal investigator to ask for pre-screening. Pre-screening is free and never obligates you to enroll.