November 11th is Veteran’s Day, a day we honor those who have served in the military for our country. Unfortunately, many veterans who have served in combat come back home suffering from PTSD. Posttraumatic stress disorder (PTSD) is a debilitating condition affecting up to 8% of the population at some point in their lives.
The statistics among veterans, however, are staggering in comparison. According to a 2020 survey, 83% of all US veterans and active duty service men and women have experienced PTSD since the 9/11 attack due to their military service. PTSD was the second-most reported severe mental injury sustained during service, after sleep issues, in the veterans and active duty service men and women participating in the survey.
PTSD is a condition that can result from experiencing or witnessing any traumatic (physical or emotional) event. Up to 20% of individuals who have survived episodes of sexual assault, physical or emotional abuse, neglect, accidents, natural disasters, or military combat can develop this illness.
PTSD may affect some individuals for the rest of their lives, with or without therapy. PTSD is a condition where certain situations trigger the sudden onset of irrational and intrusive thoughts, memories, and fears related to the original stressor. This condition can bring about panic attacks, nightmares, flashbacks, and various phobias, leading to social avoidance, headaches, anxiety, depression, pervasive guilt, and withdrawal from friends and loved ones. PTSD can result in problems at work and with relationships, as well as difficulty with personal advancement and growth, and can increase the risk of drug and alcohol abuse and suicide.
Medical treatment for PTSD traditionally involves SSRI antidepressants, antipsychotics, anxiolytics, and other medications, all with variable success rates, high incidence of untoward side effects, and slow onset of benefits. Psychotherapeutic treatment modalities include cognitive behavioral therapy and eye movement desensitization reprocessing. These therapies have a significant role in treating PTSD but can take an extended period to have a lasting effect on the patient’s functioning. They also tend to provide variable and incomplete relief for many patients.
Ketamine infusions are a new tool in the treatment of PTSD. They lead to rapid improvement in PTSD symptoms, in many cases, after the first treatment. The efficacy of ketamine in the treatment of PTSD was noted in the 1990s when injured soldiers who were treated with ketamine, either as an analgesic or surgical anesthetic, rarely went on to develop PTSD, compared to 30% of soldiers developing PTSD if treated with opiates and other anesthetics during surgery.
It is surmised that ketamine blocks the N-methyl-D-aspartate (NMDA) receptors increasing glutamate in the regions of the brain involved in emotion and long-term memory formation. This causes the suppression of maladaptive emotions and memories, allowing access to more adaptive neural circuitry and leading to more positive emotions and fewer negative memories. However, ketamine infusions are not a cure for PTSD and should be considered an adjunctive therapy that may provide rapid and lasting symptomatic relief from this condition. Therefore, patients who have PTSD are advised to continue with other therapies with the guidance of a mental health professional.