After returning home from active duty, soldier Bassheva Trenk felt as though something significant had shifted inside. Afflicted with intense despair, tortured by lack of sleep and vivid nightmares, Trenk was unable to function in her everyday life. Even a trip to the grocery store left her feeling on edge, hypervigilant, and fearful of anyone standing too closely behind her in the checkout line.
“When I got out of the Army, I was in a state of complete misery. I had no idea how I was going to get through,” says Trenk. Removed from the comfort and familiarity of home and reeling from the effects of trauma, Trenk struggled considerably.
Even under ideal conditions, military service takes a toll on one’s mental health. War, combat, toxic leadership, and other traumas all challenge the wellness of service members and—unfortunately—are not uncommon. Coupled with an individual’s mental makeup prior to enlistment, prolonged periods of extreme mental, emotional, and physical stress can increase the risk of developing post-traumatic stress disorder (PTSD).
Although PTSD can manifest in a multitude of ways, this debilitating anxiety disorder is typically triggered by an especially harrowing event—usually one that the victim experienced directly or witnessed firsthand. Memories or flashbacks of the event can haunt victims, leaving them feeling endangered, irritable, and afraid. The disorder can be so debilitating that for some, suicide seems like the only recourse. According to the U.S. Department of Veterans Affairs, 20 military veterans commit suicide on an average day—the majority of whom are veterans of the Vietnam War.
In her darkest hour, Bassheva Trenk came dangerously close to enlarging that tragic number. Fortunately, her attempt was forestalled. After Trenk recovered, a close friend begged her to seek help and graciously offered to cover Trenk’s living expenses until she could get back on her feet. This act of generosity allowed Trenk to find her way to Tim Amoroso, a staff affiliate of the VA Medical Center (VAMC) in West Haven.
Down the hall from Amoroso’s office, buried deep within the sprawling VA Connecticut Healthcare complex, flyers and pamphlets adorn the corkboard and visitor seating area, offering relief to veterans afflicted with treatment-resistant PTSD. Funded in part by the multi-institutional Consortium to Alleviate PTSD (CAP) and in partnership with the VA and Yale University, a team of researchers that includes Amoroso investigates a novel approach to treating the disorder. It is one of the first clinical trials in the country to evaluate the effectiveness of ketamine, an anesthetic most commonly used in veterinary surgery, as part of PTSD therapy.
The CAP study traces back to a significant breakthrough made in the 1990s by John Krystal, MD ’84, HS ’88, the Robert L. McNeil, Jr. Professor of Translational Research, professor of psychiatry and of neuroscience, and chair of the Department of Psychiatry. Along with his colleagues at the time, Krystal discovered that ketamine has substantial and rapid effects on patients suffering from major depression. Later, Ronald Duman, PhD, FW ’88, the Elizabeth Mears and House Jameson Professor of Psychiatry and professor of neuroscience; and George Aghajanian, MD ’58, HS ’61, FW ’63, professor emeritus of psychiatry, found that ketamine’s efficacy lies in its remarkable ability to restore synaptic connections in the brain. Dennis Charney, MD, HS ’81, conducted a pilot study suggesting that ketamine may also reduce the symptoms of PTSD. With these pieces in place, the present CAP study was born.
Amoroso—a former Army Ranger (2-75th)—is recruiting active-duty personnel and veterans between the ages of 18 and 70 who have been diagnosed with PTSD but have had little success with their prescribed antidepressants. His goal is to enroll 100 participants. After they are cleared for the study, participants are then randomized into three separate groups: a placebo group (which receives a saline infusion); a low-dose group (which receives 0.2 mg/kg of ketamine); and a high-dose group (which receives 0.5 mg/kg of ketamine).
When participants like Trenk attend their infusion appointments at the VA, they are asked to complete a handful of surveys to establish their baseline mood and demeanor that day, participate in an interview, and discuss any notable side effects or adverse events since their last session. Once approved by the VA doctor on staff, their infusion begins; it lasts about 40 minutes.
“Ketamine is safe, well tolerated, and has a relatively minor side-effect profile (compared to the traditionally available antidepressants),” explains Lynnette Averill, PhD, an associate research scientist in psychiatry and member of the VA research team. “I’ve seen people change before my eyes after an infusion—the tension in their face changes, their affect changes, and the next day they are hardly recognizable. It’s exciting and rewarding work to witness this and be part of their journey.”
Chadi Abdallah, MD, FW ’13, assistant professor of psychiatry, and his colleagues are very optimistic about the study thus far and look forward to assessing the comprehensive results in 2020. Ketamine’s potential to create positive change in people’s lives is enormous. “The success of the [study] may show that ketamine could be safely and effectively administered to veterans suffering from refractory PTSD,” says Abdallah. “It may potentially provide the required evidence to expedite the implementation of this investigational treatment across the VA health system.”
Although no longer in the study, Trenk still undergoes infusions once every month or so (in combination with her antidepressant medications), she credits ketamine with several positive changes. She reports being able to sleep more soundly, has noticed a significant reduction in the frequency and severity of her anxiety, and has even enrolled in a general-studies program at her local community college. With renewed confidence, Trenk has set her sights on a bright future.
“Ketamine has had an obvious impact on my life. When the effects start to fade away and my anxiety and aggression return, that’s how I know how big of an impact it has had. I’m not 100 percent recovered, but I’m doing so much better now.”