A Study to Evaluate the Efficacy and Safety of Esketamine for Reduction of Symptoms of Major Depressive Disorder

This study tests whether esketamine (a fast-acting antidepressant given as a nasal spray or infusion) can quickly reduce severe depression and suicidal thinking in children and adolescents who are acutely at risk and require hospitalization. **You may be eligible if...** - You (or your child) have been diagnosed with major depressive disorder - You (or your child) have serious, active suicidal thoughts or urges that require a hospital stay - Depression scores are severely elevated (CDRS-R total score ≥ 58) - Medical tests show you are physically stable enough to participate **You may NOT be eligible if...** - You (or your child) have bipolar disorder, intellectual disability, autism, conduct disorder, or psychosis - You meet criteria for borderline personality disorder - You have a history of seizures - You have allergies or sensitivities to ketamine, esketamine, or midazolam Talk to your doctor to see if this trial is right for you.