How the FDA can help American veterans suffering from PTSD

In April, around 700 veterans, active-duty troops and Gold Star families made the trip to Camp Pendleton in California for the 20th reunion of those who participated in the Battle of Ramadi. As I looked out over the crowd of men I had commanded in Iraq, I saw the faces of people I am proud to have served alongside, mentored and built lasting relationships with.

But as the reunion continued and I spoke individually with many of the battalion’s members, instead of building on the triumphs of 2004, I heard stories of lives affected by post-traumatic stress disorder (PTSD) that commonly included troubled marriages, substance abuse and turbulent post-service lives. While this was not spoken of as a complaint, these Marines were clearly hoping for help.

Speaking to them at the reunion, they asked me a simple question: “Sir, we joined the Corps and consider ourselves Marines for life. We never questioned our orders, nor the missions that you assigned, but now nobody is answers the [radio] net when we call for help.”

Americans are suffering from a national PTSD crisis, and those who are suffering the most are our veterans. Thirteen million Americans suffer from PTSD, the majority of whom are veterans or survivors of sexual or domestic abuse. PTSD is one of the few psychiatric disorders that accurately predicts the transition from thinking about suicide to making a suicide attempt, killing up to 16,000 veterans each year.

Yet there have been no new FDA-approved PTSD treatments for nearly 25 years.

However, in 2017 the FDA designated midomafetamine, more commonly known as MDMA, as a “breakthrough therapy” because of clinically demonstrated evidence in treating the root causes of PTSD. One study found that after just three sessions of MDMA-assisted therapy (MDMA-AT), 67 percent of participants no longer met the diagnostic criteria for PTSD.

Despite the promising results, an FDA advisory committee recently declined to recommend MDMA-assisted therapy as a treatment for PTSD. The committee voted 10-1 that the benefits of the therapy don’t outweigh the risks — even while clinical studies showed clear promise — cherry-picking small procedural concerns.

Yet these new treatments clearly work much better than the options currently available. Unlike MDMA-AT, which treats the root causes of PTSD, the current treatments for the disorder simply numb the pain. Today, there are only two medications that are FDA-approved for the treatment of PTSD: Zoloft and Paxil. Although SSRIs like these can work for some patients, they are not effective for everyone and generally only reduce the severity of symptoms.

This approach is clearly not working. Studies estimate that, on average, 17 to 44 veterans commit suicide every day. If the FDA doesn’t approve this treatment, the death toll will continue to rise.

Today’s American military is a volunteer force, but the branches of the armed forces are struggling to recruit, as more people conflate military service with broken veterans. I completed two tours of recruiting duty during my career, and even served as the commanding general of Marine Corps Recruiting. On recruiting duty, much time is spent talking to parents and families, trying to calm their fears about the transitions of their children to military service.

Once in service, these young warriors do everything that we ask of them without question, experiencing stress and sometimes traumatic events. Yet upon their return from service, we often abandon them. How do we expect people to volunteer to serve if we can’t take care of them?

By failing to help our veterans, we are also failing to support their families — PTSD affects everyone. Members of my family have served for over 100 years, going back to the service of both my grandfather and grandmother in World War I. But my family, like so many others, did not escape unscarred. My father landed at Normandy in 1944, fought in the Battle of the Bulge, and remained in Europe as part of the American occupation until 1946. He struggled for the rest of his life with PTSD and substance abuse. Now, 80 years after my father and so many other young Americans fought valiantly on Utah Beach, we are still struggling to serve those who have served us.

Who is going to help the men I saw at the reunion at Camp Pendleton? They have 40 or 50 more years of living with their PTSD, isolated on little islands across America without any means or resources to get the care they need. These men committed to our country when they were 18 years old, and now our country is turning its back on them by rejecting the new, promising path of treatment.

The FDA should do the right thing and approve this treatment. So many veterans — young and old alike — are in desperate need of a helping hand, and it’s about time our nation’s leaders lent one. If they don’t, I fear that many members of my battalion will be lost to this illness. My hope is that, by the next reunion, we can celebrate lives restored, not mourn more lives lost.

Paul Kennedy is a retired major general in the U.S. Marine Corps. During his service, he helped lead combat operations in the War on Terror, first as a battalion commander in Iraq and then as regimental combat team commander in Afghanistan.