Abstract: The disclosure relates to methods for reducing symptoms of major depressive disorder, including suicidality, in a human patient assessed to be at imminent risk for suicide comprising the administration of esketamine in addition to standard of care treatment. In certain embodiments, the methods comprise determining if the patient has previously attempted suicide, and, if so, treating such patient with a standard of care treatment and a therapeutically effective amount of esketamine, whereas patients determined not to have previously attempted suicide are administered standard of care treatment without treating the patient with esketamine.