Accumulating evidence supports a significant effect of the analgesic ketamine in the short-term treatment of suicidal ideation. Here, I will present findings from a large multicentric study conducted in France (Abbar et al. 2022; Jollant et al. 2024): 156 hospitalized patients with current suicidal ideas were randomized to intravenous (IV) racemic ketamine (0.5mg/kg over 40min) or placebo as an add-on treatment. All patients received two IV infusions at 24h-interval. At day 3, rates of full suicidal remission were superior with ketamine than placebo (63.0 vs 31.6%: OR=3.7 (1.9-7.3)). The effect was particularly important in patients with a bipolar disorder. Side effects were limited and non-severe. No robust predictive clinical factor was identified. A mediating effect of psychological pain was identified. About 40% of patients maintained a sustained suicidal remission over 6 weeks while evolution was more fluctuating in 50%, and 10% showed no response to ketamine. At week 6, no group-difference was found mainly due to improvement in the placebo group (69.5 vs 56.3%; ns). A review of literature (Jollant et al. 2023) confirmed the benefits of IV racemic ketamine, but not esketamine, on suicidal ideation. Practical applications will be discussed.