If 4.48 Psychosis is a howl of pain, an attempt to stage suicidal depression, then turning it into an opera, an artform not unfamiliar with tragedy and high emotion, should work. But while much of Philip Venables' new production works brilliantly, some of the raw pain of the text is lost.

Venables, doctoral composer-in-residence for the Royal Opera House, has crafted an inventive adaptation, which treats Sarah Kane's own formally-inventive script – lacking characters or context – as a score to be animated in many varied ways. Her words are spoken, sung, pre-recorded, projected; there's a sense of deep engagement with the text, Venables finding musical equivalents for its anger, misery, poetry and humour.

A plain white room – with chamber ensemble Chroma, conducted by Richard Baker, peeping out above it – can be a bedroom, or medical institutional. Of the cast of six women, identically dressed in drab grey jeans and cardigans, one (soprano Gweneth-Ann Rand) seems to be a protagonist; the rest float around her, fragments of a divided self, while mezzo-soprano Lucy Schaufer takes on the more defined role of her doctor. The women sing solo, in overlapping cacophony, and in unison, occasionally crunching between song and spoken words (not always effectively: some of the spoken lines have a declamatory staginess).

It may be an opera, but the best invention must be the syntactical use of percussion. The text of conversations between patient and doctor – frequently fraught; frequently very funny – is projected on the walls, accompanied by percussion beating a spoken emphasis. A drum, a hammer and a saw pound accusingly, or ping question marks; the emphasis, the emotion, comes through in the voice of the instrument as much as in the written word. This doesn't sound all that, but boy does it work in the space; 4.48 Psychosis is worth watching just for those sections.

Elsewhere, there are longueurs: the singing stretches things to ninety minutes and it's no short sharp shock, more a thorough wallow. Venables has said he wanted to turn back to the text, rather than the personal reading of it (Kane committed suicide after finishing the play), but there's an unexpected risk that it actually becomes too bloodless. The sheer beauty of these powerful voices places the audience at a sort of aesthetic remove. I noticed the poeticism of the language, admired the soaring gorgeousness, but what is lost is the jagged, abrasive immediacy of Kane's writing. I felt I was witnessing a lamentation of despair, not sucker-punched by it.

Still, this is brutally hacked through musically at certain moments: one pretty aria is gradually overwhelmed by horror-movie strings, the orchestra increasingly discordant as it descends like a slowly deflating balloon. It's a staggeringly, appropriately ugly sound.

There are also dotted instances of real fizzing energy, with Venables' score rising to the challenges of Kane's text with thrilling urgency. The woman's mental countdown – created with giant projected numbers – comes with a hectic, parping, jazzy score that sounds like a Gershwin overture gone nastily awry; this returns to soundtrack rattled-off lists of medicines and their grim side-effects. It's wacky, but sparkling, whipping up the humour.

There's less spark to Ted Hoffman's pretty absent direction: the singers largely just drift around the stage. Yes, there's already a lot going on in the text and music, but it's still a very dreary simplicity. And the more lively sections don't really work: when chairs are knocked and clothes chucked around, Kane's expletive-laden rage - "fuck you for rejecting me… fuck my father for fucking up my life" - comes to look like adolescence petulance.

4.48 Psychosis is an open text: it always demands incisive, decisive responses from those who stage it. Venables' production, through ever-shifting styles from the mournful to the manic, has found a musical answer to Kane's open invitation - even if it hasn't found an equivalently dynamic way to stage it.

Read our interview with the composer of 4.48 Psychosis here


4.48 Psychosis is at the Lyric Hammersmith till 28 May.