Ketamine for Veterans with PTSD - A New Study
Written by Annais Linares and edited by Dr. Ko
When veterans come home, their experiences can return with them. Sometimes their memories (especially traumatic ones) continue to vividly pop up in their heads, even to the point where they are reliving their traumas years after those events occurred. Experiencing emotional and psychological triggers after witnessing or being part of a terrifying event is known as Post-traumatic Stress Disorder (PTSD), a mental health disorder.
PTSD usually manifests into nightmares, flashbacks, uncontrollable thoughts, and severe anxiety. You can recognize PTSD symptoms, as opposed to healthy processing of the experience, if they continue to worsen, interfere with daily life, and/or if they last for long periods of time (i.e. months or even years after the event). For veterans in the United States, over 10% have had PTSD in any given year, with each conflict experience (such as the Vietnam War) averaging different percentages. This suggests that the severity of each event might play a role in how many people develop the disorder. Some of the most common kinds of traumatic events that lead to post-traumatic stress disorder include combat exposure, physical violence, and being threatened by a weapon. These types of events often occur to those who actively serve in a combat zone, which can impact them for a prolonged period after the event.
Although there is no way to know for sure who will or won’t develop PTSD, there are a few methods to treat it. Unfortunately, in the general population of Americans, of those who do develop the disorder and seek treatment approximately 33% are treatment resistant. When this happens, people often start to lose hope and feel like they are incapable of living like they had prior to the traumatic event. If they don’t feel supported by others, have other mental health issues, or have a job that exposes them to more traumatic events (e.g. first responders, firefighters, etc), it can become even more difficult to deal with treatment resistant PTSD.
So, what can a veteran do if all else has failed?
Recent studies suggest that ketamine infusions may hold potential for those diagnosed with PTSD. Although ketamine has already been used off-label to treat depression, anxiety, and chronic pain, it is becoming clear that patients with PTSD may also benefit from the treatment. According to a recent article published in November 2019, thirty US military veterans with combat-related PTSD who passed a medical screening, were not taking lamotrigine or any monoamine oxidase inhibitors, and did not have psychosis underwent six 1-hour ketamine infusions as part of an observational study.
Each participant received a starting dose of 1mg/kg of body weight, which was then adjusted afterward based on their experiences. The dose was intentionally aimed at creating a psychotherapeutic response - defined as the dose “at which the patient experiences the optimum transpersonal and transformative experience.” The study used a higher dose than other ketamine studies, which typically begin at 0.5mg/kg. Each patient sat on a recliner for the period of the treatment for one hour with a healthcare provider in the room. They stayed in place for approximately 30 minutes after each infusion to recover. Infusions were administered over a two to three week period of time based on the scheduling availability of each veteran. The veterans typically watched nature videos and listened to a relaxing soundtrack during their treatment, with a few exceptions.
The reason for this study was to discover whether ketamine, typically used as an anesthetic, could be used to treat PTSD. Therefore, the veterans were asked to fill out questionnaires related to PTSD, depression, alcohol use, and drug abuse prior to their first and last treatment. The questionnaires showed no increase in depressive symptoms, with 7% of veterans reporting no change. In PTSD symptoms, 10% endorsed an increase in symptoms. Nevertheless, those who benefitted from the ketamine showed a significant decrease of symptoms (~50% reduction). Furthermore, in this study, “'participants were also asked to describe their experience regarding the dissociative and psychomimetic effect of the ketamine and their perceptions of the value of psychotropic therapeutic response as part of their therapy.”
The researchers concluded that “high-dose ketamine infusion therapy, which induced transpersonal dissociative experience, could be a valuable tool in the treatment of combat-related PTSD.” The researchers emphasized that the dissociative experience was not simply a side effect of ketamine, but rather an essential component to the treatment. Some patients reported that the ability to achieve a change in their belief systems and their ability to “reset” their thought patterns helped them to transform the meaning behind their traumatic experiences. Of note, other than nausea, there were no significant adverse side effects or vital sign abnormalities from the high doses of ketamine.
Other element the researchers believe impact the outcome are “set and setting.” The staff member present helped to ground and guide each veteran through their ketamine journey in order to provide supplemental healing processes typically absent in traditional Western medical practices.
One limitation to this study is its length. The results were determined over the course of two to three weeks and did not follow up long term. Another limitation is that the questionnaires were filled out prior to the first and last infusion, not after the last infusion. Therefore, the data gathered was relative to five total infusions instead of the total six administered. The researchers addressed this limitation by stating that they preferred to obtain a “complete data set after five infusions rather than to risk losing patients to follow-up after they completed their full series of six.”
The last limitation addressed in the research was the difficulty in assessing the ketamine’s impact on the veterans’ use of alcohol and other illicit drugs. The veterans often did not trust the researchers and admitted that they were not honest when filling out these forms. The researchers could not gather clear data due to this and therefore did not conclude anything about the use of substances in relation to ketamine infusions, however, a few of the patients anecdotally reported that their desire to drink alcohol significantly went down.
Although the study provides more evidence that ketamine impacts patients with combat-related PTSD, further study is needed to conclude ketamine’s definitive role. But the researchers believe that ketamine’s experiential and psychotropic effects are critical to healing, which are amplified with higher doses of ketamine.
The body of evidence behind ketamine’s impact on mental health is growing. This study further supports the use of higher-doses of ketamine, especially in relation to depression and PTSD.
At Reset Ketamine, we have had treatment-resistant patients who have benefited from these infusions, giving us hope for others who are also suffering.
If you or a loved one is struggling with depression, PTSD, anxiety, or chronic pain, please contact us now for a consultation to see if you would be an ideal candidate for ketamine treatments.
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