Expanding Ketamine Application for Treatment of Acute Suicidality in Long-Duration Spaceflight.

Long-duration spaceflight increases the risk of psychiatric emergencies, including acute suicidality, due to factors like isolation, helplessness, and bereavement. Ketamine has emerged as a rapidly effective intervention for acute suicidality on Earth, with advantages including stability, ease of administration, and a favorable safety profile. This literature review of 122 publications, including 23 randomized controlled trials, examined ketamine's potential as a safe, effective pharmacological tool for treating acute suicidal ideation during space exploration missions. The authors argue that as behavioral stressors increase with extended missions, ketamine offers a multifaceted option for behavioral health support, though the review does not aim to revise current International Space Station protocols.

Study at a glance

Abstract

The transition to exploration missions places a heightened risk on behavioral health in spaceflight. Although serious psychiatric emergencies during spaceflight have been rare, longer duration missions increase the possibility of emergence in latent mental health disorders due to genetic predisposition, increased autonomy, isolation, helplessness, loss of family member, or catastrophic events. Complicated grief and bereavement have the highest rate of suicidal ideation. Recently, ketamine has been used as an emergent intervention for acute suicidality, promoting its stability, ease of administration, favorable safety profile, and outcomes for reduction of suicidal intent. The goal of this study was to review current literature and collate the understanding of ketamine as a safe, effective pharmacological adjunct for acute suicidality in spaceflight. This literature review was conducted to collate data on ketamine use for acute suicidality and inform on stability, limitations, and utilization of ketamine within extreme environments. There were 122 publications reviewed for relevance, including 23 randomized-control trials for ketamine use in behavioral emergencies. Ketamine is a diverse pharmaceutical with multiple advantageous indications, including acute suicidality, pain, and sedation. Terrestrial use of ketamine suggests a rapidly efficacious medication for reduction in acute suicidality. As behavioral stressors expand related to extended missions, contingencies for behavioral emergencies become increasingly important. Although this review is not intended to redevelop current International Space Station protocols, it is the first to discuss the benefits of ketamine in spaceflight as a potential safe, effective, multifaceted tool for exploration missions and treatment for acute suicidal ideation. Kutz CJ, Mistry AM, Dukes CH. Expanding ketamine application for treatment of acute suicidality in long-duration spaceflight. Aerosp Med Hum Perform. 2025; 96(6):509-519.