Shortly before Memorial Day 2019, the U.S. Army used Twitter to pose a question to active service members and veterans: “How has serving impacted you?” More than 11,000 responded, many with harrowing stories of depression, post-traumatic stress and other mental health woes.
“How did serving impact me? Ask my family,” one man tweeted back, according to NPR. He reported a “Combat Cocktail” of “PTSD, severe depression, anxiety, isolation, suicide attempts and never ending rage.” Another said, “I can’t function in society because of my major depressive disorder. So now what?”
There are about 20 million veterans in the United States, and they have a suicide rate 1.5 times greater than nonveterans, according to the VA. In a Rand study, nearly one in five soldiers who served in Afghanistan and Iraq returned with PTSD or depression.
But there is new cause for hope. Ketamine—a painkiller used as a field anesthetic during the Vietnam War and one of the World Health Organization’s “essential medicines”—is now emerging as a powerful and fast-acting antidepressant. It shows promise as a remedy for veterans who haven’t found relief anywhere else.
Depression and Ketamine
Depression isn’t just a problem for veterans; it afflicts nearly seven percent of American adults and is the leading cause of disability worldwide, as reported by Time. About 70 percent of clinically depressed people respond well to antidepressant medications, but the remaining 30 percent continue to suffer.
Researchers at Yale and other leading research and clinical institutions are finding that ketamine provides dramatic improvement, particularly among patients who have had no luck with other medications. “In the past 20 years, I’ve not seen anything like this,” said Cristina Cusin, head of the ketamine clinic at Massachusetts General Hospital.
I share Cusin’s enthusiasm. In my 32 years as a physician treating patients—including veterans—for depression, I have never seen a medication that works so well. At my clinic, we see an 85 percent success rate with patients who treat their depression with ketamine infusion therapy in a professional clinical setting.
Help for Veterans
Ketamine doesn’t just provide short-term relief. By rebuilding neural connections and recruiting the glutamate system, it allows the body’s natural mood elevators to flow more freely over the short and long term.
That can provide a lifeline for military men and women.
President Trump recently advocated providing Spravato, a derivative of ketamine administered in a nasal spray, to veterans suffering from severe depression. However, clinicians have mainly relied on ketamine administered through IV infusions because they are able to more precisely adjust the dosing for individual patients.
In a recent study, veterans suffering from PTSD and major depressive disorder experienced a sharp reduction in suicidal thoughts after receiving IV infusions of ketamine over a 12-day period, according to a presentation at the March 2019 conference of the Anxiety and Depression Association of America.
People with both PTSD and major depression face a suicide risk three times higher than patients grappling with just one of the disorders, a University of Minnesota psychiatrist and researcher told the group, as covered in a recent article in Healeo Psychiatric Annals. But the 15 veterans who received a total of six ketamine infusions showed “significant improvement” in their mental health and outlook on life.
Becoming Widely Available
For two-and-a-half years, the San Francisco VA Medical Center has used ketamine to treat veterans whose symptoms of PTSD and depression have not responded to other treatments. According to a December 2018 article, infusion center director Tobias Marton said the results have been “impressive.”
At a veterans’ convention in August, Trump said Ketamine has “an incredible effect” for treating depression among veterans, and VA doctors are beginning to prescribe it for patients based on individual needs.
New VA guidelines call for health care providers to screen veterans for suicide risk and prescribe psychosocial and pharmalogical treatments—including IV-infused ketamine—as needed, according to MedPage Today. With almost 20 veterans dying each day by suicide, and countless others struggling with depression and PTSD, the need is clear.
At clinics around the country—including mine—veterans treated with ketamine are finding immediate relief from depression they feared would never go away. With a restored sense of clarity and hope, they are able to resume their normal lives—and feel the gratitude of a nation they risked their lives to serve.