Background <p>Suicide is a serious public health concern that requires urgent and effective treatment. Electroconvulsive therapy (ECT) and ketamine are two well-researched options, especially for people with depression with associated suicidality. This systematic review examines the available comparative evidence for these two interventions in reducing suicidal thoughts and other associated suicidal behaviors.</p> Methods <p>We conducted a systematic search on PubMed, Scopus and through cross-referencing to identify the relevant studies. We focused on randomized controlled trials that have compared ECT and Ketamine for their impact on suicidality as an outcome.</p> Results <p>None of the available studies comparing ECT and ketamine have evaluated suicidal ideations and other suicidal behaviors as the primary outcome. Only six studies have assessed the suicidal ideations and suicidal behavior as secondary outcome, and these suggest that both interventions have comparable efficacy in reducing suicidal ideation. However, the existing literature is limited by use of different instruments and unvalidated scales.</p> Conclusion <p>At present, there is limited comparative evidence for ECT and ketamine on suicidal ideations and suicidal behaviors. The available research indicates that the two interventions differ with regards to timelines of efficacy, safety profiles, and long-term outcomes, though a consensus is still lacking.</p>