A British study concluded that veterinarians experience the highest incidence of suicide compared to all other occupations, outranking dentists and doctors in risk factors. Research conducted by Dr. Richard Mellanby and published in the Veterinary Record in October of 2005 indicates that the suicide rate for the veterinary profession is four times higher than that of the general population and twice as high as that of doctors or dentists. Veterinarians who specialize in equines are particularly susceptible.
  
A number of stress issues were cited as cause for the high incidence in veterinarian suicides, among them: compassion fatigue, irregular hours, overwhelming workloads, the expectations and demands of clients, working in an environment of psychological or physical isolation and a lack of tools or resources to deal with stress.  
 
Veterinarians are minimally trained, if at all, in psychological issues to cope with the emotional states of their human clients. During vet school, little is addressed in terms of juggling financial aspects of running a practice or anything outside of the technical core complexities of clinical veterinary medicine. Career-threatening litigation is another factor that enters into the stress equation.  
 
In the last several decades the collective consciousness has elevated animals to a status on par with humans. Animals have been absorbed as intimate members of the extended family unit and with that membership comes equality in their level of importance. The responsibility of the veterinarian to maintain the health of these family members creates enormous pressure.
 
Additionally, stress factors for the veterinarian include the stringent pace and long hours which take a toll on personal and family relationships. A paradox becomes clear. The majority of veterinarians pursue their field of interest as a by-product of their deeply compassionate and empathetic natures. Their objective is to heal, to alleviate or reduce the pain and suffering of others, an altruistic and lofty goal. Yet maintaining a healthy level of emotional detachment with their patients and clients is contrary to the core essence of the occupation.
  
Another paradox is that veterinarians tend to be perfectionists, constantly intent on improving themselves and dedicated to putting forth a 180% effort. As a whole, they are deeply committed to the welfare of their patients and clients. And when they fail to heal, when they fail to prolong the quality of life, this is often perceived as an internalized, magnified and personal defeat. High levels of self-criticism are often associated with high levels of depression. The mental, spiritual and emotional balance necessary in the field of veterinary medicine is often one of the most difficult if not elusive traits to maintain.
Additionally, the work of the veterinarian accustoms them to routinely ending the lives of animals who are suffering. This permanent solution to a situation that is beyond hope easily bleeds through as a natural alternative to their own stress levels when the magnitudes of those stresses become overwhelming.   
 
According to Richard Halliwell of the Royal College of Veterinary Surgeons, veterinarians tend to be not only conscientious but introspective. Their vulnerability to depression is magnified because of the high standards that they impose on themselves. It is estimated that 80% of suicides are a result of profound depression.
  
Dr. Raj Persaud, author of The Motivated Mind, maintains that veterinarians, particularly equine veterinarians, are often reluctant to address mental health issues due to an ingrained fear that admission of depression by highly skilled professionals such as themselves, is akin to weakness. Dr. Persaud believes that since veterinarians consistently exhibit perfectionist personality types they are all the more susceptible to depression and mental health issues. Mental illness does not always follow stress, Dr. Persaud explained. It is the inability to successfully implement strategic tactics to cope with that stress that results in an anguished, unbearable depression.
 
According to Dr. Persuad, veterinarians are traditionally problem-solvers and they find it difficult to accept that not all problems in life are solvable. He cites two ways that stress is usually resolved: by problem solving or by emotionally-focused coping. The former involves life style or environment changes. The latter involves changing the internal perception, changing the attitude. For some veterinarians, a third option, suicide, becomes a viable alternative when the other two choices seem unobtainable, unimaginable or out of reach.  
 
Finally, it’s theorized that access to potentially lethal drugs along with familiarity of euthanasia procedures contribute to the high incidence of suicide among veterinarians. According to the British Veterinary Association, lethal injection is the preferred choice among veterinarians who have chosen to end their own lives.
  
In a tempting irony, veterinarians have legal access to chemicals that can both save and destroy lives. Staring them in the face on a daily basis is the horse tranquilizer, ketamine, an anaesthetic drug that has been shown to successfully treat depression almost instantly. Standard medications to combat depression take weeks or even months before they become effective and there are no guarantees that the therapy of choice will even work successfully. The suggestion that veterinarians who are experiencing mental or emotional life difficulties might resort to occasional dosages of the drug to weather their internal storms is not unfounded.
 
In a study by the National Institute of Mental Health involving treatment-resistant patients diagnosed with acute depression, ketamine, given in low doses had remarkable effects in rapidly alleviating symptoms.
 
The drawback is that in higher doses, side effects include intense euphoria coupled with hallucinations and dissociation. Ketamine has long been associated as a drug of choice among recreational users, particularly those that frequent raves, all night dance parties, and it is often abused. There is wide spread speculation among mental health professionals studying the statistics on veterinary suicide that self medicating utilizing any number of drugs individually or in cocktail form, increases the risk of suicide.
 
Like any profession, the veterinary profession is hardly exempt from sorrows, difficulties or addictions. The desperateness of dark depression often overrides the dangers. The ease of accessibility is often too seductive to ignore, especially when the indulgence offers an immediate solution, alleviating the torture, the mental, emotional and spiritual anguish of devastatingly painful depression.  
  
For veterinarians, the order of drug abuse preference is primarily alcohol with ketamine coming in a close second followed by benzodiazepines, opiates, street drugs (cannabis, heroin, cocaine and ecstasy) and nitrous oxide. Coincidentally, studies have shown that ketamine can have a positive effect in reducing the desire for alcohol.  
 
When used in moderation, the average person can often function surprisingly efficiently when under the influence of coping-type drugs and can effectively disguise the fact that they have self-medicated. An example of this acute level of performance has been proven to be highly efficient in the battlefield. The Department of Defense has explored the use of internasal ketamine spray theorizing that an injured soldier on ketamine can more efficiently guide a tank to safety than an injured soldier sedated with morphine.
 
Although ketamine depresses consciousness at a high level, it does not disrupt breathing or circulation like most anaesthetics. This means that an anaesthesiologist is not necessary for surgery. For this reason it was used extensively in army field hospitals in Vietnam.
 
At higher doses Ketamine can produce an out-of-body effect similar to a near-death-experience.  Because of its euphoric properties and effectiveness in alleviating anguish and depression, it lends a strong possibility that could predispose suicidal after-effects. The ketamine metamorphosis of an actual near-death-experience is a double-edged sword as it reduces anxiety and fear of death, increases altruism and creates a lack of concern with material goals. This effect in itself could cause the suicidal act to be perceived as desirable, a spiritual experience.
  
The Federal Centers for Disease Control and Prevention released statistics in a new five-year analysis of the nation’s death rate among the general population. Of the more than 32,000 people who committed suicide in 2004, 14,607 were 40 to 64 years old; 5,198 were over 65 and 2,434 were under 21-years-old.  Males are 75% more likely to commit suicide than females.
 
On the cutting edge of offering a solution to the problem of veterinarian burn-out is Dr. Elizabeth Strand, the founding Director of Veterinary Social Work, (VSW) a collaborative effort between UT’s College of Veterinary Medicine and College of Social Work. The VSW is designed to address the emotional issues of veterinarians and their clients.  Dr. Strand explained that veterinarians experience death at five times the rate of human doctors. Suffering of their patients cause further emotional draining of the animal health care professional and can lead to illness, depression and suicide. She stresses that vets need to be kind to themselves.
 
When the oxygen masks drop down from the overhead compartments as the airplane is spiraling down, out of control and in a panicked, rudderless spin, the flight attendants calmly instruct passengers to adjust the mask on their own face before trying to assist other passengers. It’s an image that everyone who cares for animals, particularly veterinarians, needs to indelibly imprint in their memory banks.