Suicide, as a result of mental health disorders, is one of the reasons why ketamine is considered an option to treat PTSD in American veterans. In 2013, the United States Department of Veteran Affairs released a dismaying statistic about suicide rates. The study was conducted from 1999 to 2010 and reported that approximately 22 veterans were dying by suicide every day.
It’s also troubling to realize that the American veteran suicide rate was double the national average for civilians. Approximately 14 civilian suicides occurred in the same period (per 100,000 citizens) versus 30 deaths by suicide by military veterans. The data was not adjusted for age or gender, but by division. The U.S. Army had the highest rate of veteran suicide; about 52% of all cases involved former infantry.
In response to the alarming report, the Clay Hunt Veterans Suicide Prevention Act was passed in the Senate in 2015. This Act required the Veterans Affairs healthcare division to undergo regular evaluations of mental health care and suicide prevention programs. It also required ongoing updates to resources for veterans to aid in suicide intervention.
A more recent survey conducted by the Veterans Affairs (VA) in 2016 reported little improvement. The sample studied the medical records of 55 military veterans in the United States. It was reported that 20 veterans die from suicide every day. The report indicated that 31% of the tragic suicides were from veterans aged 49 years or younger and 69% of the reported suicides were veterans aged 50 years and older. 97% of the recorded suicides were male patients of the VA.
Understanding Combat Veterans and the Diagnosis of Post-Traumatic Stress Disorder
It takes a strong individual to serve in the American military. Our soldiers are placed in life-threatening and difficult situations that prove challenging to emotionally process. Serving under the constant threat of death or personal injury to you or a comrade creates traumatic experiences that can last a lifetime.
The American military does provide psychological support services and counseling. However, the culture of the military and the stigma attached to mental illness or disorders makes many personnel hesitant to report symptoms of post-traumatic stress disorder (PTSD). Soldiers are conditioned to suffer in silence and not indicate any weakness through the culture of military training. They are reluctant to seek help while they are on active duty, and after they have retired from military service.
Trauma does not just go away. No matter how much you try to push it out of the subconscious, it has a way of bubbling back to the surface with life-disrupting symptoms. Some of the warning signs or symptoms of PTSD include:
Nightmares or unwanted memories
Avoidance of activities that trigger a memory of the trauma
Irritability and emotional reactivity
It is no coincidence that the American veterans struggle the most with symptoms of post-traumatic stress disorder (PTSD). While engaged in military service, soldiers are surrounded by a team environment and occupied daily with activities that help, in some cases, to suppress the emotions and symptoms of PTSD. However, when they leave active duty and return to civilian life, that level of daily regimented activity disappears. With that loss of functional distraction, veterans can succumb to paralyzing trauma that they may have suppressed for years.
Why do they feel like they cannot talk to anyone about it? Consider how horrified the average non-military person would be to hear the accounts of the violence and tragedy that many American veterans experience in active duty. The reason there are so many veteran support organizations and groups across the country is that vets feel they provide the only community that can understand their trauma.
Male veterans account for 97% of reported suicides. Without stereotyping by gender, many research studies have confirmed that men are less likely to pursue medical consultation, counseling, or help when they feel overwhelmed with a mental health issue. Societally, men are discouraged from showing what they perceive to be a weakness. Male veterans can struggle in silence and be misunderstood for aggressive behavior, which may actually be expressions and symptoms of moderate to severe PTSD.
Conventional Treatment of Trauma and Mental Health Disorders for American Veterans
Veteran’s Affairs provides healthcare services to military men and women who have completed active duty or retired from service due to a health issue or injury. There is a division exclusively for the treatment of post-traumatic stress disorder within the VA for military veterans who suffer debilitating symptoms. The therapeutic approach is through psychotherapy treatments.
There are three conventional healing services provided through the Department of Veteran’s Affairs and the National Center for PTSD:
1. Prolonged Exposure (PE)
This therapeutic method teaches veterans how to gain control of emotionally reactive moments by facing negative feelings. The Prolonged Exposure (PE) therapy model identifies the fear or trauma event and the emotional triggers that stimulate a negative stress response. Therapies allow veterans to ‘face their fear,’ examine it, understand the triggers, and work to process the trauma in a healthy way with counseling and support.
2. Cognitive Processing Therapy (CPT)
The CPT method of a therapeutic intervention for veterans teaches a different approach to help reframe negative thoughts about the trauma. Often veterans can be self-critical about the difficulties they encounter as a result of the trauma they sustained during active service. This method typically involves counseling and writing therapy. It also encourages veterans to journal their feelings to deepen self-awareness and empathy for the cause of the trauma, while teaching supportive techniques to manage symptoms of stress, anxiety, and depression caused by PTSD.
3. Eye Movement Desensitization and Reprocessing (EMDR)
The EMDR therapeutic approach for veterans aims to help patients suffering from post-traumatic stress disorder by desensitizing them to stimuli that trigger panic attacks and symptoms of depression. This therapy retrains the veteran’s cognition to disassociate certain physical triggers, such as loud sounds and rapid peripheral movement, with the trauma event(s).
In some states, private intensive therapy services are available for veterans when conventional therapeutic treatments do not work. This type of therapy can be administered to the veteran either privately with a specialized practitioner, or in a group setting, such as a trauma therapy retreat. However, intensive therapy services are not covered by insurance plans and are not affordable for many American veterans.
Anti-anxiety medications and anti-depressants are also used in conjunction with psychotherapy treatment for American veterans with varying degrees of success. Because of the scope of the trauma that many veterans experience, they may withdraw from relationships with family and friends. That isolation, coupled with the use of different psychotropic medications, contributes greatly to the increased suicide rate for American veterans.
Drug Addiction as a Symptom of Post-Traumatic Stress Disorder
Veterans who have not responded to conventional therapeutic plans can segue easily into addictive behaviors as a distraction from the trauma. This can include smoking cigarettes, using recreational cannabis, or abusing drugs (such as opioids, NSAIDs, and alcohol).
When trauma proves to be debilitating for the veteran, drug abuse may be the only effective relief from their symptoms. In one particular study, drug abuse was found to be the precursor to 30% of veteran suicides.
What makes the treatment of drug and alcohol abuse challenging for veterans? Substance abuse may have started while they were serving in the military. While random regular drug screenings are part of every branch of the United States Military, it is still common. Alcoholism is the most common drug abuse and addiction for American military veterans. There are no penalties for recreational alcohol use, and it does not have the same consequences as Schedule I or Schedule II drug use.
All military bases are federal property, and the United States Federal Government defines cannabis, and other controlled substances, as illegal. There are no provisions for medical cannabis use for active personnel soldiers. They can face fines and incarceration for a first-time offense, and repeat offenses can result in a felony charge. Military servicemen and women are required to submit to a urine analysis annually.
Veteran’s Affairs (VA) Legalized Ketamine Treatment for American Soldiers with PTSD
There are currently more than 20 million military veterans in the United States who have a higher than average rate of mental health challenges. These include depression, debilitating anxiety, and post-traumatic stress disorder.
One of the most exciting clinical discoveries about ketamine is that it does more than provide immediate relief from depression, trauma, and PTSD. Ketamine helps by rebuilding the neural connections in the brain and stimulating the glutamate system, which allows natural mood hormones to flow more freely. Essentially, ketamine helps veterans by making trauma easier to process and cope with on a daily basis.
Veteran’s Affairs (VA) has approved the use of ketamine IV infusions for therapeutic benefit. In fact, ketamine was previously permitted and administered to American soldiers in the Vietnam war. There are also derivatives of ketamine, such as Spravato, that are administered by nasal spray for fast-acting relief of depression and anxiety. The nasal spray—generally known as esketamine—was also endorsed by the Trump Administration in 2019.
During the March 2019 conference of the Anxiety and Depression Association of America, a new clinical study offered some interesting clinical insights. Veteran participants in the study experienced a strong reduction in suicidal thoughts after focus treatments that lasted for twelve days. By June 2019, Veteran’s Affairs had approved the use of ketamine infusions for the treatment of severe depression, suicidal ideation, and post-traumatic stress disorder (PTSD) for veterans who had not responded to other types of therapies.
“V.A. will closely monitor the use of esketamine in veterans to more fully understand its relative safety and effectiveness as compared to the other available treatments. Based on this information, V.A. may revise its clinical guidance and the availability of the drug for retired military personnel.“
– Veterans Affairs
The V.A. is currently running private trials to test the success rate for veterans in a ketamine program. It has committed to covering the cost of ketamine therapy for military veterans diagnosed with treatment-resistant forms of clinical depression, for retired servicemen, and women most at risk of suicide-related to mental health disorders. However, the available ketamine therapy is only available to veterans through prescribed esketamine, and not though IV infusion methods of administration by a health practitioner. There are some exceptions, though. In select states, it is available in clinics.
The Study and Statement of the Efficacy of Ketamine from Yale School of Medicine
Yale School of Medicine stated what health practitioners and veterans with PTSD and severe clinical depression already knew; ketamine is extremely effective at treating clinical depression, severe anxiety, and post-traumatic stress disorder (PTSD).
“A large body of research demonstrates that ketamine, an investigational antidepressant, may be effective at reducing symptoms of PTSD, and specifically SI in a rapid manner. Research suggests that ketamine’s effect begins within two hours after dosing and peak approximately 24-hours after treatment. Considering the incredible burden and risk for those with severe PTSD symptoms and SI, fast-tracked anti-suicidal effects are urgently needed.“
As more clinical studies of the use of ketamine for treatment-resistant depression in patients are reviewed, American veterans who have suffered in silence have some new hope. Ketamine therapies can activate neural sensors and help break veterans free from moderate to severe symptoms of depression and post-traumatic stress disorder (PTSD).
What is most promising about the early research findings for ketamine in the treatment of PTSD is is that the effects can last from several weeks to months, post-treatment. That means that veterans could be rehabilitated and then placed on a regular therapeutic maintenance program to prevent relapse and reduce the rate of suicide.