The Great Ketamine Boogie Woogie

Uncle Sugar says the age limit is gone. Apparently, I’m still too old.

Try to recall an early scene in Joseph Heller’s classic satire Catch 22 when Yossarian’s frustration level is unbearable. He demands the squadron clerk, ex-PFC Wintergreen allow him to see his boss, Maj. Major, but the good major can’t be seen. He is out when he’s in, and out when he’s out. Yossarian’s frustration worsens because he knows he’ll never get to meet him.

What does that have that to do with anything? Until a few days ago, nothing. Thanks to the Veterans Administration (VA) reality now mirrors fiction.

Fifty-seven years ago, I was an infantry platoon leader in Vietnam. Vivid memories of that time are never more than a split second away. I am a card-carrying member of the PTSD club and have been diagnosed with what is referred to as treatment-resistant depression. 

Thirty percent of patients diagnosed as clinically depressed are treatment resistant. That means we’re special; drugs don’t work on us. I have taken every happy pill that Big Pharma has cranked out over the past four decades and personally checked off most every adverse reaction/side effect listed in the PDR, the Physicians’ Desk Reference of pharmaceuticals, all without positive and sometimes adverse results. 

Medical research has made great progress in alternative therapies for my variety of depression. 

I learned of these radical therapies while reading a treatise entitled, The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma, by Bessel van der Kolk, M.D., which details how trauma impacts and is physically manifested in our bodies. 

Photo by Peter Herrmann

The new menu of modalities includes: TMS, temporal magnetic stimulation to the pre-frontal cortex; psilocybin or “magic mushrooms;” electroconvulsive therapy that is guaranteed to wipe out a good chunk of one’s memory banks à la R. P. McMurphy in One Flew Over the Cuckoo’s Nest. They offer ketamine (an anesthesia medication in higher doses), esketamine, a nasal-spray derivative of the former drug, and others. I read the patients’ testimonials about ketamine and I longed to share their success. It seemed almost too good to be true.

Eighteen months ago, I learned the VA has a huge quiver of psyche tools, the result of many government-funded research studies: Magic mushrooms, LSD, things previously considered harmful are now used to effectively treat ‘sticky’ depression, the kind that doesn’t respond. The government, affectionately referred to as Uncle Sugar, widened it’s quiver of available tools to combat PTSD. Timothy Leary's mantra sixty-five years after he advised us to turn on, tune in, and drop out is now standard operating procedure at Uncle Sugar’s VA Medical Centers.

The VA imposed an age limitation; no patients older than age sixty-five qualify. The reason given is the potential for increased intracranial pressure, which translates to fear of strokes. I know from experience you can’t fight City Hall, so I gave up seeking Uncle Sugar’s help.

I pursued ketamine therapy at personal expense, outside the VA medical system because it sounded so right. The board-certified neurologist I consulted said the VA’s age restriction was, and I am quoting, “Absolute bullshit! We are there to monitor you and react appropriately if that happens.” 

I underwent a four-week course of therapy with an $8,000 price tag, none of which was reimbursed by the VA, but I knew that from the get-go. The results were outstanding; a lightness of being I sought for decades, but it did not effect a cure, but it caused an improvement in my mood.

I learned the VA’s ketamine age restriction was removed and requested a consultation through my regular VA psychiatrist. Within weeks I was in a Zoom session with a VA doctor to determine whether I’d qualify for ketamine therapy.

The Zoom session started, and I made an introductory statement of my clinical history underscoring the lack of success with a laundry list of antidepressants. I requested to be considered a ketamine candidate since the age restrictions were eliminated.

The doctor replied essentially saying the medical equivalent of, “You can’t get there from here.” I am paraphrasing, but the following is close. The doctor opened with: “Yes, it’s true the age restriction has been removed, but the clinical data indicates ketamine is problematic in older patients, so in your case, the age limitation remains. You do not qualify because of your age.”

I queried. “So, the age restriction was not eliminated, right?”
“No, the age restriction was eliminated.”
“Doc, I don’t follow you. If the age restriction was removed, then it would logically follow that there is no reason I should not qualify for this therapy.”
“You’re too old.”
“Doctor, I’m not trying to be disrespectful, but are you listening to yourself?”
He didn’t reply other than to restate the conclusion that I don’t qualify.

I shook my head and laughed as the video conference ended. Whether the doctor noticed my cynical laugh did not cross my mind; I didn’t care. 

I wanted to scream, “Yossarian! I found Maj. Major!”

Michael Hennessy