DOD Peddling Non-Answers in Mental Health Debate

by Rick Rogers

 

Last week I sent the Department of Defense questions sparked by a series of new reports appearing in American, British and Australian medical journals questioning the efficacy of mental health drugs so widely prescribed by our young and old veterans.

In the interest of full disclosure, I provide first the questions and then the Defense Department’s reply.

  • What is DOD’s current position concerning prescribing antidepressants and antipsychotics to the troops? What drugs are judge compatible with military deployments and which, if any, are barred from being taken in Iraq and/or Afghanistan?
  • Here is an excerpt from the 2 Aug. 2011 NYT story based on a study appearing in the Journal of the American Medical Association. The story was entitled, “Drugs Found Ineffective for Veterans’ Stress”: “I think it’s a very important study” given how frequently the drugs have been prescribed, said Dr. Charles Hoge, a senior scientist at the Walter Reed Army Institute of Research. He added, “It definitely calls into question the use of antipsychotics in general for PTSD.”

Does the DOD take exception to anything written in the NYT piece?

Is the DOD reviewing its medication policy in light of the JAMA study?

According to government (TRICARE) figures from 2002 to 2008, mental health prescriptions increased from 3.7 million to 6.4 million and that by 2008 antipsychotics prescription numbered 686,400. Of that number, nearly 296,000 were for Seroquel, a drug that researchers say is likely no more effective than Risperdal, which was prescribed nearly 163,000 times in 2008 alone.

In 2009, it’s been reported, almost 87,000 veterans with PTSD received prescriptions for an antipsychotic, and in 94 percent of cases the prescription was for a second-generation agent.

In reviewing the medical literature on antipsychotics, no where do I see that they (second-generation antipsychotics) were ever found effective in treating PTSD, yet huge numbers of them have been prescribed for that condition for almost 10 years. What medical evidence did DOD act on to prescribe antipsychotics for PTSD? How was this decision arrived at? Who made the call?

What I did find is that antipsychotics are most often prescribed for schizophrenia and bipolar disorder. How many of these drugs were actually prescribed for these disorders and not PTSD

If Risperdal and other second-generation antipsychotics were no more effective than a placebo, why were so many prescribed?

  • From Bloomberg story dated Aug. 10, 2011: “Johnson Johnson said it reached an agreement to settle a misdemeanor criminal charge related to marketing of its antipsychotic drug Risperdal

“The U.S. has been investigating its Risperdal sales practices since 2004, including allegations the company marketed the drug for unapproved uses, JJ said in its quarterly filing yesterday. The Justice Department and the U.S. attorney in Philadelphia “are continuing to pursue both criminal and civil actions,” the company said.

  • Did JJ ever suggest/pitch/offer information to the DOD that Risperdal was effective in PTSD treatment? How much money has DOD spent on Risperdal and other antipsychotics since 2004?
  • Did the DOJ ever tell the DOD that it had questions concerning Riperdal?
  • What are the advantages of prescribing antidepressants and antipsychotics for those with PTSD instead of having them go through counseling? Does DOD plan to advocate counseling over the prescribing meds in the future?
  • Some in the psychology and social work community say that psychotropic drugs should have no role to play in mental health treatment because they are not effective and have adverse side affects. What is DOD’s best argument as to why these drugs are indeed effective in treating PTSD, depression, etc., in troops?

The questions try to nail down who knew what when and for how long. In my mind the single most important questions were:

  • Did the New York Times get the story right and is DOD considering a policy change?

This is the Defense Department’s response that arrived after my deadline last week.

The Department is committed to providing our men and women in uniform with the best care possible. Antidepressants, and other psychotropic medications, when used with proper medical supervision, in appropriate situations, and usually in conjunction with other treatments, are important and effective tools for supporting Armed Forces mental health needs, both in theater and at home.

DOD utilizes medication as a treatment option, but not the only option, for psychological health problems if deemed appropriate by a licensed health professional.

The VA/ DOD Clinical Practice Guidelines for psychological health conditions include recommendations for both in garrison and in theater care examining psychotropic, psychological, and other forms of treatment based on current scientific literature. These CPGs serve as one means of communicating the state of the evidence to providers in the field. These guidelines are developed by an expert multidisciplinary panel of DOD and VA providers, and include comprehensive and rigorous review of the effectiveness of medication and associated side effects that can contribute to negative outcomes such as suicide.

The VA/DOD PTSD clinical practice guideline includes a review of the evidence for use of atypical antipsychotics. These medications are not recommended as the single treatment for PTSD. However, expert consensus-based recommendations indicate their use as an adjunctive medication for targeted symptom relief.

Psychotropic medications can be prescribed for a variety of reasons besides psychological health conditions, including recurrent headaches, pain and smoking cessation.

Even by government standards, this press release posing as a response to query is a joke.


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