As the 10th leading cause of death in the United States, suicide claims over 44,000 lives a year and causes immeasurable pain for the friends and families of victims, as well as their communities at large. Luckily, in recent years, suicide rates have begun to plateau within the general public. This trend, unfortunately, has not held true for one distinct subpopulation: active service members and recent veterans.
Historically, suicide rates within the military have been lower than those of the general population. Yet, since the early 2000’s and the wars in Afghanistan and Iraq, the rate of suicide attempts by service members and recent veterans has been steadily climbing, out pacing nearly any other group.
A Solution for Service Members with Suicidal Ideation
Service members with suicidal ideation face a unique set of challenges. As traditional treatments can take weeks or months to be effective, service members have little choice other than psychiatric hospitalization. While clearly preferable to imminent suicide, psychiatric hospitalization may create a host of long-term problems for service members. For one, this form of treatment may isolate service members, separating them from their respective support networks. Additionally, hospitalization carries a culturally-specific stigma, which is rooted in a military mentality that views mental health treatment as a sign of weakness or being damaged. Yet, maybe most significantly, psychiatric hospitalization can create administrative obstacles to returning to duty, ultimately alienating service members from seeking further treatment.
An Alternative to Psychiatric Hospitals?
Deployed or remotely stationed service members face the additional challenge that psychiatric hospitals may simply not be accessible.
Unfortunately, despite growing need, treatment options for service members remain limited. For more than 50 years, monoamines and SSRI’s have been employed for the treatment of depression and suicidality in the military, despite these drugs limited and delayed effectiveness.
Yet for the first time in decades, there is new hope for our military service men and women. In the past decade, low-dose, intravenous (IV) ketamine therapy has emerge as a novel therapeutic that is highly effective at treating severe unipolar depression, bipolar depression and suicidality. What sets ketamine therapy apart from traditional treatment options is its rapidness. Ketamine works fast! Patients can expect to see improvement in their depressive symptoms after only a single 40-minute treatment, and the entire treatment course only lasts 2-3 weeks.
Ketamine treatment for suicidality is particularly useful in an emergency setting, like that of a combat zone. Ketamine near instantaneously relieves suffering and allows for the patient to survive long enough for longer-term treatments to be administered and take effect. In this way, ketamine therapy could be critical in a remote posting, potentially eliminating the need for dangerous and costly medical evacuations. Likewise, this treatment could allow patients to avoid hospitalization all together, alleviating the stressors and administrative hurdles associated with that form of in-patient treatment.
A recent double-blinded, placebo-controlled study published in Military Medicine found that there was a statistical improvement in suicidal and depressive symptoms for those treated with IV ketamine. This study drew from a population of active service members presenting symptoms during admission to military hospitals. Patients were treated and subsequently followed throughout the discharge process and 2 weeks post-treatment. The majority of the patients who received iv ketamine experienced a dramatic decrease in suicidality and hopelessness within 40 minutes. No such improvements where observe in any of the control subjects.
Moving forward, researchers must continue to investigate the most effective implementation strategies for IV ketamine therapy in the military. Future research will also have to determine the effectiveness of IV ketamine for long term symptom management in the field. In the meantime, the results from existing studies are still enormously positive and suggest that ketamine has the potential to be a critical tool in combating military suicide.