The following is based on an article in the NY Times on 4/6/13 by Richard Friedman, MD.
The Use Of Psychoactive Drugs In War
Last year, more active-duty soldiers committed suicide primarily from depression and addictions than died in battle. Another statistic, only somewhat less startling, is that drug prescribing for the use of psychoactive drugs in the military between 2005 and 2011 rose nearly 700 percent. These include antipsychotics, sedatives, stimulants and mood stabilizers. In particular, prescriptions written for antipsychotic drugs for active-duty troops increased 1,083 percent while the civilian population increase was just 22 percent. This increase in medication is taking place despite a steady reduction in combat troop levels since 2008.
This brings up that possibility that military doctors might be prescribing psychoactive drugs to enable soldiers to function better in combat. And although antipsychotic drugs have been used off-label in the treatment of insomnia, anxiety and aggressive behavior, we have no idea whether they’re effective — or safe — to use on a continuing basis to treat war-related stress and anxiety or to numb or sedate those affected by it.
Furthermore, while the military (and others) uses antipsychotic drugs to treat post-traumatic stress disorder (PTSD), there is weak evidence that these drugs are an effective treatment for it. In 2007, PTSD was the most common off-label diagnosis for the use of psychoactive medications. Yet a recent clinical trial involving 300 veterans found that the antipsychotic risperidone to be no more effective than a placebo in treating PTSD.
In treating soldiers who have PTSD symptoms with antipsychotic medications, the military might be violating its own treatment guidelines, In February 2012, the assistant secretary of defense for health affairs, Dr. Jonathan Woodson, wrote in a memo to the military’s leadership that the “greatest concern is the suspicion of the over-prescription of antipsychotic medications for PTSD.”
Prescription Drugs In War
There are additional concerning prescription trends in the military. For example:
- The number of prescriptions written for potentially habit-forming anti-anxiety medications — like Valium and Klonopin — rose 713 percent between 2005 and 2011.
- The use of sedating anticonvulsants — Topamax, Neurontin and Lyrica — increased 996 percent during this period.
- The limited use of antidepressants, which are generally at least moderately effective in treating the symptoms of depression, anxiety and PTSD. Antidepressant prescriptions dropped by 48 percent between 2006 and 2009. Since both depression and PTSD are associated with increased suicide risk, it is conceivable that this drop played a role in increasing suicide rates among troops.
- Increasing evidence that the military favors quick-acting — and less effective — anticonvulsants and antipsychotics over antidepressants, which can take weeks to work.
Another reason to be concerned regarding liberal off-label use of antipsychotic medications is long-term adverse health risks, including tardive dyskinesia, a potentially irreversible movement disorder.
Medical oversight is required in the development of new treatment guidelines for combat-related syndromes like traumatic brain injury (TBI), PTSD, depression and stress-related disease. Increased oversight might also identify innovative off-label uses of psychotropic drugs that would benefit both our troops and the general population.