Every year, the Veterans Administration (VA) confronts the startling reality that US Armed Forces veterans are losing their lives to suicide at an increasingly alarming rate. Based on data from the “2023 National Veteran Suicide Prevention Annual Report,” despite a 2.3% decrease in the Veteran population from 2020 to 2021, the total number of suicide deaths increased, from 6,278 to 6,392. Here in the Tampa Bay area, securing VA approval for IV ketamine therapy for veterans often proves challenging and requires a “Community Care Consult.” We hope today’s blog opens a conversation for change.
-
Introduction
- Understanding the Plight of Veterans
- The Urgency of Addressing Veteran Suicide
-
The Promise of IV Ketamine
- How Ketamine Works
- Ketamine’s Suicidolytic Properties
- Benefits Over Traditional Treatments
-
The Challenge of Traditional PTSD Medications
- Limitations of Current FDA-Approved Medications
- The High Cost of Side Effects
- Focus on Sexual Dysfunction
-
Navigating the “Off-Label” Landscape
- What Does “Off-Label” Mean?
-
The Case for IV Ketamine in PTSD Treatment
- Comparing Ketamine to FDA-Approved Options
- The Current Landscape
- A Closer Look at the Numbers
-
Veteran Suicide Statistics
- The Current Landscape & A Closer Look at the Numbers
-
A New Path Forward
- How InnerVision Psychiatry Can Help
-
Call to Action
- Reaching Out for Help
- Resources for Immediate Support
- Not-For-Profit Companies Supportive of Veterans Seeking Mental Health Reform
-
Conclusion
Introduction
Understanding the Plight of Veterans
Like most mental health providers, when I first read through the 2023 National Veteran Suicide Prevention Annual Report, I found the statistics to be very unsettling. The thought of someone choosing to risk their life to serve our country only to retire from service and take their own life is infuriating. How could something so tragic be so commonly overlooked? What is causing this silent epidemic of veteran suicide, and how can we change its course?
The Urgency of Addressing Veteran Suicide
Consider the urgency of veteran suicide. Here we have documented proof that we are losing veterans to suicide at an increasing rate, year after year. You would think that if there were a treatment available to veterans which has been proven to decrease suicidal ideations, the VA would be in full support of it, right?
The Promise of IV Ketamine
How Ketamine Works
I have outlined ketamine’s proposed mechanism of action in another post, but I will recap today. In summary, we know that IV ketamine antagonizes (or “blocks”) a receptor known as NMDA on glutaminergic interneurons. This then leads to a host of downstream effects, culminating in what is known as “neuroplasticity.” In simple terms, this is an increase in neuronal cell growth that allows your brain to heal & build new connections.
Ketamine’s Suicidolytic Properties
One of the most impressive aspects of IV ketamine treatment for veterans, is its implications for suicide prevention. The suicidolytic properties of IV ketamine have been documented and replicated for decades at this point. Even a single infusion has been shown to significantly decrease suicidal ideations from the first 24 hours and out to 7 days. Opponents of ketamine often aim to discredit these benefits, citing a lack of sustainability. Interestingly enough, these opponents often disregard evidence proving the contrary: example 1, example 2, example 3, and example 4.
Benefits Over Traditional Treatments
When you compare the efficacy of IV ketamine therapy for veterans versus the standard of care (SSRIs, SNRIs, antipsychotics), you find yourself finding more questions than answers. VA providers often lean towards “FDA approved” treatment modalities first, which is reasonable. These include psychotropic medications and various psychotherapies. But what happens when these fail, or when veterans find themselves unable to tolerate these treatment modalities? If the algorithm ends at “FDA approved” options, veterans will find themselves without options quicker than you’d expect.
The Challenge of Traditional PTSD Medications
Limitations of Current FDA-Approved Medications
As of March 2024, there are only two FDA approved medications for PTSD: sertraline (“Zoloft”) and paroxetine (“Paxil”). For major depressive disorder and varying anxiety disorders, this number expands to fluoxetine, citalopram, escitalopram, fluvoxamine, venlafaxine, desvenlafaxine, duloxetine, mirtazapine, levomilnacipran, amitriptyline, nortriptyline, imipramine, desipramine, and clomipramine, bupropion, phenelzine, tranylcypromine, isocarboxazid, and selegiline. Oftentimes, veterans find themselves having trialed and failed >5 different medications throughout the course of their illness with no significant improvement.
The High Cost of Side Effects
What’s worse is what happens when these medications are tolerated. The side effect profile of the traditional monoamine medications listed above is extensive. Some medications often make patients feel “worse than whatever I was feeling before!” Take a medication like paroxetine (“Paxil”): the incidence of sexual dysfunction has been quoted to be >61% of patients when compared to placebo.
Navigating the “Off-Label” Landscape
So why exactly do veterans find themselves struggling to get the VA to pay for IV ketamine treatments? Sadly, the answer is often simple: IV ketamine is not “FDA approved for mental health conditions.” Make no mistake, IV ketamine is FDA approved and has been an FDA approved medication since 1970. It’s also listed on the WHO’s List of Essential Medications as well. Critics argue that IV ketamine is only for anesthesia, even in the face of mountainous evidence to the contrary.
What Does “Off-Label” Mean?
Using a medication “Off-label” means that you are being prescribed a medication that does not have an FDA indication for what it is being prescribed to you for. This does not mean that it is not safe or effective. It just means that the medication has not been through the FDA approval process for that indication.
A very interesting counterpoint to the argument that ketamine is not “FDA approved” and should not be used in the veteran population is the VA’s prescribing patterns for the medication prazosin. This medication carries no FDA approval for PTSD, yet it is very commonly prescribed for the nightmares associated with PTSD, even in the face of evidence to suggest that it performs no better than placebo in the military veteran population published in the New England Journal of Medicine.
The Case for IV Ketamine in PTSD Treatment
The evidence for use of IV ketamine therapy for veterans is mounting and soon will be difficult to deny. We are seeing study after study report benefitial effects for IV ketamine for veterans, especially in cases where other options have failed (like this study using IV ketamine in veterans who had failed esketamine or Spravato). Evidence for IV ketamine to treat PTSD is also building on studies like this one from the American Journal of Psychiatry.
Comparing Ketamine to FDA-Approved Options
There is often much debate about how well ketamine works versus other options. I don’t think anyone in the ketamine space is arguing that ketamine should be a first-line option for any psychiatric illness and trying to argue that point will fall on deaf ears. What is more important is the reality that when veterans have failed 4-5 different treatment options, trying a 6th, 7th, 8th psychotropic medication is extremely unlikely to have a meaningful impact. This is something we have known in the field of psychiatry since the STAR-D trial.
Veteran Suicide Statistics
The Current Landscape & A Closer Look at the Numbers
When you look over the 2023 National Veteran Suicide Prevention Annual Report, what you will see is a grim reality of the difficulty veterans face in our society today. In 2021 alone, 6,392 Veterans died by suicide. That’s 114 more than in 2020. Suicide is still the 13th leading cause of death for Veterans overall, and the 2nd leading cause of death for veterans under the age of 45. The report itself points out “these numbers are more than statistics,” but sadly veterans often cannot get VA approval for life saving treatment alternatives like IV ketamine therapy.
A New Path Forward
How InnerVision Psychiatry Can Help
Here at InnerVision Psychiatry, our goal has also been affordability and increased access to care for those who need it the most. In addition to being the most affordable IV ketamine clinic in the Tampa Bay area, we offer discounts for active-duty and retired military veterans, as well as first responders (police, emergency medical services, and firefighters).
Call to Action
Reaching Out for Help
If you or a loved one has been struggling with treatment-resistant PTSD, depression or anxiety after the line of duty, please give us a call (813) 428-5420 or click here to schedule your free psychiatric intake examination to discuss the possibility of IV ketamine therapy.
Resources for Immediate Support
- Veterans Crisis Line: Offers 24/7 confidential support via phone, text, or chat. Veterans or their loved ones can call 1-800-273-8255 and press 1, text to 838255, or chat online.
- Military OneSource: Offers a range of support and resources for military personnel and their families, including confidential counseling.
- American Foundation for Suicide Prevention: Provides resources specifically tailored for veterans, including educational material and support networks.
Not-For-Profit Companies Supportive of Veterans Seeking Mental Health Reform
- Reason for Hope: A veteran lead team of volunteers drafting and advancing legislation, preparing policy proposals, and educating legislators and government officials on issues related to psychedelic medicine and assisted therapies.
- Veteran Mental Health Leadership Coalition: Veterans on a mission to lead in the fight to prevent suicide and deaths of despair – not only for Veterans – but for all Americans – through increased access to safe and affordable psychedelic-assisted therapy.
Conclusion
The goal of this post is to bring light to a very important topic: the treatment of suicidality in the veteran population. When other options have been tried and failed, IV ketamine therapy is a safe and effective alternative. At InnerVision Psychiatry, we’re committed to using IV ketamine for veterans struggling in the shadows of PTSD, depression, and anxiety.
Frequently Asked Questions
Acute Stress Disorder: Symptoms of ASD begin within three days of the traumatic incident and can last for up to four weeks.
Post-Traumatic Stress Disorder: PTSD is diagnosed when the symptoms last for more than a month and cause significant distress or functional impairment. If the symptoms persist for more than three months, PTSD can be considered chronic.
- Some people recover within six months, a period sometimes referred to as short-term PTSD.
- Others have symptoms that last much longer, even years, known as chronic PTSD.
- A number of factors influence how long PTSD lasts, including the severity of the traumatic event, personal and familial history, additional stressors after the trauma, and the individual’s overall mental health.
- Speak to a Healthcare Professional: This could be your primary care physician or a mental health specialist. They can provide a proper assessment and guide you to appropriate resources.
- Seek Therapy: Evidence-based therapies like Cognitive Behavioral Therapy (CBT), Eye Movement Desensitization and Reprocessing (EMDR), Low-Dose IV Ketamine Therapy and others have been effective for many individuals with PTSD.
- Stay Connected: Talk to someone you trust about your experiences. It could be a friend, family member, or support group. Connection can be crucial.
- Avoid Alcohol and Drugs: Substance abuse can worsen the symptoms and prolong recovery.
- Educate Yourself: Learning more about PTSD can help you feel more in control.
- Stay Safe: If you’re having suicidal thoughts or feeling in immediate danger, seek emergency care or call a crisis hotline immediately.
