Army warns doctors against using certain drugs in PTSD treatment

BY BOB BREWIN 04/25/2012


The Army Surgeon General’s office is backing away from its long-standing endorsement of prescribing troops multiple highly addictive psychotropic drugs for the treatment of post-traumatic stress disorder and early this month warned regional medical commanders against using tranquilizers such as Xanax and Valium to treat PTSD.

An April 10 policy memo that the Army Medical Command released regarding the diagnosis and treatment of PTSD said a class of drugs known as benzodiazepines, which include Xanax and Valium, could intensify rather than reduce combat stress symptoms and lead to addiction.

The memo, signed by Herbert Coley, civilian chief of staff of the Army Medical Command, also cautioned service clinicians against prescribingsecond-generation antipsychotic drugs, such as Seroquel and Risperidone, to combat PTSD. The drugs originally were developed to treat severe mental conditions such as schizophrenia and bipolar disorder. The memo questioned the efficacy of this drug class in PTSD treatment and cautioned against their use due to potential long-term health effects, which include heart disorders, muscle spasms and weight gain.

Throughout more than a decade of war in Afghanistan and Iraq, the military services have relied heavily on prescription drugs to help troops deal with their mental health problems during and after deployment. In a June 2010 report, the Defense Department’s Pharmacoeconomic Center said 213,972, or 20 percent of the 1.1 million active-duty troops surveyed, were taking some form of psychotropic drug — antidepressants, antipsychotics, sedative hypnotics or other controlled substances.

The Army, in a July 2010 report on suicide prevention, said one-third of all active-duty military suicides involved prescription drugs.

Mental health experts say the military’s prescription drug problem is exacerbated by a U.S. Central Command policy that dates to October 2001 and provides deploying troops with up to a 180-day supply of prescription drugs under its Central Nervous System formulary.

That formulary includes Xanax, Valium and three other benzodiazepines to treat anxiety: Ativan, Klonopin and Restoril.

The Army’s new PTSD policy makes it clear that the risk of treating combat stress with benzodiazepines outweighs the rewards: “Benzodiazepine use should be considered relatively contraindicated in combat veterans with PTSD because of the high co-morbidity of combat-related PTSD with alcohol misuse and substance use disorders (up to 50 percent co-morbidity) and potential problems with tolerance and dependence.”

Read the entire Broken Warriors series.After becoming dependent on these drugs, soldiers face enormous problems when they try to discontinue their use, the report said. “Once initiated in combat veterans, benzodiazepines can be very difficult, if not impossible to discontinue, due to significant withdrawal symptoms compounded by underlying PTSD symptoms which can only be compared to the likes of a Cymbalta withdrawal treatment or something of a similar nature,” the document said.

The Army policy memo highlighting problems with benzodiazepines for PTSD treatment dovetails with a study published in the April issue of Current Psychiatry Online by Jolene Bostwick, clinical assistant professor of pharmacy at the University of Michigan College of Pharmacy.

Bostwick wrote “benzodiazepine administration fails to prevent PTSD and may increase its incidence.” She added, “use of benzodiazepines for PTSD is associated with withdrawal symptoms, more severe symptoms after discontinuation and possible disinhibition, and may interfere with patients’ efforts to integrate trauma experiences.”

Army clinicians who prescribe Risperidone, Seroquel and other second-generation antipsychotic drugs “must clearly document their rationale concluding that the potential benefits outweigh the known risks and that informed consent has been conducted,” the policy memo said.

Seroquel has been implicated in the deaths of combat veterans and theVeterans Affairs Department reported in August 2011 that Risperidone was no more effective in PTSD treatment than a placebo. VA spent $717 million on the drug over the past decade. The military has spent $74 million over the past 10 years on Risperidone, a spokeswoman for the Defense Logistics Agency said.

An Army doctor who declined to be identified told Nextgov “these long-overdue policy changes are welcome, but they will further shift the mental health care of soldiers to an already overstressed VA and will result in the separation of many mentally stressed volunteers, who just months earlier had been counseled to steel themselves for a career of perpetual deployment and had been willing to sacrifice the best years of their lives to do so.”

This long-serving Army clinician said, “the nation needs to take a long, hard look at what delayed the institution of these policies, and why the priorities of our Army medical leaders have too often favored the manpower needs of the Army rather than the mental health of its soldiers.”

Dr. Grace Jackson, a former Navy psychiatrist who resigned her commission in 2002 “because I did not want to be a pill pusher” said the new Army policy shows “they are finally admitting to some problems associated with at least one class of psychiatric medication.” But, Jackson said, the Army policy does not address problems with other classes of prescription drugs, including antidepressants and selective serotonin re-uptake inhibitors (SSRIs), such as Prozac, in the treatment of PTSD. Clinical studies, Jackson said, have shown these drugs to be no better than placebos — but far more dangerous in the treatment of PTSD.

The Army also has ignored the role antipsychotic drugs play in the “sudden death” of troops diagnosed with traumatic brain injury due toundiagnosed endocrine abnormalities Jackson said.

The use of antipsychotic drugs to treat troops with TBI can cause changes in growth and thyroid hormones, which can in turn trigger a variety of cardiac-related events that could result in sudden deaths, Jackson said.

Though the Army has adopted a new policy on the use of benzodiazepines, Jackson said the Defense Department overall is still wedded to a policy of using drugs to treat mental problems even when scientific evidence “demonstrates poor risk-benefit ratios.”

The Army policy memo encouraged clinicians to look beyond drugs to treat PTSD and suggested a range of alternative therapies, including yoga, biofeedback, acupuncture and massage.

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6 Responses to Army warns doctors against using certain drugs in PTSD treatment

  1. Billy Foos says:

    Combat Veteran – I was taken off of Clonazepam about 5 months ago and life has been hell…. Not only do I live in this mental hell but I know there is help that I cannot have…. if any va medical staff see this post I pray they help the next veteran in my position. I have daily suicidal thoughts. I accuse my gf of being unfaithful… I cannot hold a job… I sweat perfusely simply when a song comes on the radio That reminds me… My sheets stay drenched. .. My world is a living shit… Maybe Clonazepam wasn’t a cure but at least it offered me a good day here and there… I’m losing everything I have left.

  2. Wrenae says:

    Yall need a douche! I was on 2 mils of Xanax four times a day and jerked off of it only to be force fed Respidone! What Hell !if I was ever going to Kill my self it would have been then!!!!!!!!! Now since I am over Court appointed forced injections and ask for just a little bit of Xanax just to be normal they want me on Lithium??? You all made this bitch now what are you going to do with her? I at least deserve a treatment facility to learn how to live without it!! I was on this med for 15 years!!! What do you pricks think all high and mighty? Read this! Now all I can hope for is that my current liver function tests stay 28 so I can drink myself to sleep no thanks to the Feds…no treatment for Vets.

  3. Wrenae says:

    The forced injection were Resperdone!! They don’t work! And make non suicidal Vets just that!!!!

  4. Larry Fowler says:

    B.S. y’all have no clue nor will u that’s why Veterans is in jail for yalls turning your backs and giving us bullshit medicine not related nor helps the ones that work u take and make bullshit excuses. Why don’t y’all take your suits off and go play with us then tell us what works and don’t. You all are to high paid sit behind a desk and know shit.

  5. Larry Fowler says:

    That is exactly why Veterans is killing rate is 22 a day the blood is on the suit wearing scared to go to war but have all the answers y’all should be ashamed our blood on SCARED CHICKEN SUIT WEARING DONT KNOW SH.. ABOUT US

  6. jon smith says:

    I was going through hell. I could not eat or sleep for 4 days at a time. My body would collapse from stress for about 3 hours. My blood pressure was about 200 over 120 heart rate of 157 bpm. I would regain conscious and start all over again. I went to a psychiatrist outside of the VA. He put me on Klonopin and told me to come back tomorrow so he could review me. Let me tell you everything went back to normal as in sleep no stress no bad dreams no flash back no painful memories blood pressure normal heart rate normal. This Medication Saved My Life. I have been on it for a few years now with no problems. I told the VA. to kiss my A=ss and I am not going to be a guinea pig no more. I went outside the box and got help. My friend is still being treated by the VA and they switch his meds ever month. Now my friend is so bad he hardly knows who I am and the VA wants to put him in a mental facility and take his benefits away. The VA has basically Killed my best friend. Thanks VA for a job well done. He was my Partner. No he wasn’t subject to anything any different than I was. We went through it together if any of you at the VA Can Speak English. To all of the veteran’s My brother’s I know what the VA system it doing to you and I know what your going through For I was there to. you can get help outside of the system as a secondary form of help and still get your benefits. What they don’t know is that doctors don’t go against each other as a code of ethics. Best of Luck always and my heart goes out to you. May god be with you and help each and everyone of you. if you need to talk. Take care my brother’s.

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