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Someone who was never in the military will likely still have a clue about how difficult and stressful military life can be. They are also likely to have a sense of how combat situations, losing comrades could increase the risk of suicide. What someone who has never served will commonly not understand is how stressful events that occurred during active service can stay with a veteran for the rest of their life. This is why PTSD increases the risk of veteran suicide. The service member leaves the service but the trauma they experience remains with them forever.

Relationship Between PTSD and Suicide

Studies of combat-related PTSD going back to the Vietnam era indicate that a strong predictor of thoughts of suicide and suicide attempts is guilt related to combat situations. Veterans live with thoughts that they cannot turn off or suppress. They experience huge amounts of guilt related to these past situations. The guilt may relate to what the veteran did years ago or what they believe they failed to do. The veteran lives in the physical world of today but in their memories they are still in southeast Asia. Research has shown a three-fold increase in suicidal ideation and a sense of hopelessness in veterans with a PTSD diagnosis compared to veterans without PTSD.

PTSD Predicts Suicide Risk Even When Combined with Other Issues

There are many things that can increase the risk of suicide in veterans. Other mental illness issues like bipolar disorder, depression, and schizophrenia increase suicide risk. Social isolation, substance abuse, difficulty readjusting to civilian life, and loss of a significant relationship all increase the risk of suicide. Researchers have addressed how this mix of issues relates to suicide. The bottom line is that if you remove PTSD from the situation in any of these cases the risk of suicide goes down. If you add PTSD to any of these situations or conditions, the risk of suicide goes up. PTSD by itself and in combination with other mental health issues and/or situations increases the risk of suicide.

Does Treating PTSD Reduce the Risk of Suicide?

Going back a decade there is good evidence that successful treatment of PTSD reduces suicidal thinking and risk of suicide. While PTSD treatment is going on is when suicidal thinking is most completely suppressed or eliminated. However, thoughts of suicide are also reduced long after a person has completed PTSD treatment. A study published this year showed that in a residential treatment program cognitive processing therapy (psychotherapy or talk therapy) both improved or eliminated PTSD symptoms and concurrently reduced thoughts of suicide.

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PTSD Treatment and Concomitant Suicide Risk

A practical consideration that therapists are forced to deal with in treating PTSD is not precipitating more suicidal thoughts or a suicide attempt. In general, the most effective cognitive therapy for PTSD is a trauma-focused cognitive-behavioral therapy. This approach takes the person right back into their trauma and teaches them how to deal with it. The goal is to put the past in the past and get it out of the present. However, when a veteran is considered at high risk of suicide the therapists may hesitate in using this effective approach. The concern is that the veteran will not develop the coping skills in time and the therapy will end up precipitating a suicide attempt. Thus, all too often, therapists do not proceed aggressively enough with their therapy and there may still be a suicide attempt!

The Place for Psychedelics in Treating PTSD

Coaching, psychotherapy, and trauma-focused cognitive-behavioral therapy are all terms used for and variations of the talk therapy necessary to help a veteran with PTSD get better. Where the psychedelic medicine, MDMA, comes into the picture is that it cuts down the anxiety that patients experience when recalling traumatic memories. The memories feel less confronting which lets the patient and therapist work through old issues effectively. This is something that is virtually tailored to deal with the practical therapeutic issue of not pushing things too aggressively for fear of precipitating more suicidal thoughts and attempts. With MDMA likely to be passed by the FDA next year for treating PTSD along with talk therapy or coaching, this is excellent news for treating PTSD and reducing the risk of suicide.

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