Questions Mount About Military and VA Use of Mental Health Drugs

By Rick Rogers


Three recent studies suggest the Defense Department and Department of Veterans Affairs should re-examine their protocols on psychotropic drugs to treat post-traumatic stress disorder and other mental health conditions across generations of patients.

Combined, the studies from the United States, Great Britain and Australia scrutinize the medical establishment’s penchant for medicating a wide swath of mental maladies, ranging from garden-variety melancholia to severe psychological issues arising from PTSD.

The Australian study, released in late July, looked at a troubling relationship between elevated levels of common anti-depressants and fatal acts, including murder and suicide.

Two of the studies —- from the United States and Britain —- were first reported on Aug. 2.

The one in the British Medical Journal found that people over 65 taking serotonin reuptake inhibitors, which are antidepressants, were at greater risk of dying or suffering strokes, falls and fractures than those taking older, tricyclic antidepressants, which themselves were not free from adverse side effects.

But it is the U.S. study (the largest of its kind), appearing in the Journal of the American Medical Association and focused on a specific antipsychotic drug routinely prescribed to treat PTSD, that is most striking.

The drug’s name is Risperdal. The study concluded that among patients with military-related PTSD with symptoms resistant to serotonin reuptake inhibitors, Risperdal proved no more effective than a placebo —- but that the second-generation antipsychotic had worse side effects, including weight gain, and less commonly, suicidal thoughts.

Long-term adverse health effects linked to these antipsychotics included heart issues and diabetes.

According to the website, Risperdal is primarily used to treat schizophrenia, bipolar mania and autism.

“We didn’t find any suggestion that the drug treatment was having an overall benefit on their lives,” John H. Krystal, director of the clinical neurosciences division of the Department of Veterans Affairs’ National Center for PTSD and the lead author of the study, said in a media report.

His new research looked at 267 patients at 23 Department of Veterans Affairs medical clinics from 2007 to 2010. Placebos were given to 134 patients, while 133 were given up to 4 milligrams of Risperdal daily.

“Overall, the data do not provide strong support for the current widespread prescription of Risperidone (the generic name) to patients with chronic serotonin reuptake inhibitor-resistant military-related PTSD symptoms, and these findings should stimulate careful review of the benefits of these medications in patients with chronic PTSD,” the authors said.

The researchers, from Yale University, said they believe the results are applicable for the entire category of antipsychotic drugs and not just Risperdal.

Government figures from 2002 to 2008 show mental health prescriptions increased from 3.7 million to 6.4 million, and that by 2008 antipsychotic prescriptions numbered 686,400. Of that number, nearly 296,000 were for Seroquel, a drug that researchers say is probably no more effective than Risperdal, which was prescribed nearly 163,000 times.

In 2009, according to the JAMA study, almost 87,000 veterans with PTSD received prescriptions for an antipsychotic, and in 94 percent of the cases the prescription was for a second-generation agent.

The military has spent an estimated $1.1 billion on mental health drugs from 2001 to 2009. It is not known how much was spent on antipsychotics.

Last week, Johnson Johnson agreed to settle a criminal charge brought by the U.S. government, sparked by the company’s marketing of Risperdal dating to 2004 —- including allegations that the company peddled the drug for unapproved uses.

Here’s a question: If government lawyers knew there was a potential problem with Risperdal —- and by extension, other antipsychotics —- why didn’t the military?

Last year, jurors in Louisiana ordered Johnson Johnson to pay $257.6 million to the state for making misleading claims about Risperdal’s safety. The company has appealed.

In June, a South Carolina judge ordered JJ officials to pay $327 million in penalties for deceptively marketing the medicine. The company is asking the court to throw that verdict out.

Approximately 40 other states are considering similar litigation.

“Pill and bill” has become so inculcated a medical custom in our swallow-and-forget society that it’s overshadowed an often-forgotten section of the Hippocratic Oath that reads, “I will remember that there is art to medicine as well as science, and that warmth, sympathy and understanding may outweigh the surgeon’s knife or the chemist’s drug.”

Not in our military.

As I write this, the Army is reporting the highest number of suspected suicides ever: 32 for the month of July. Mind you, this is all going on while the military is medicating its troops at the highest recorded rates in the history of warfare.

Think there is any connection?

And yet our military leaders look hound-dog sick when asked to explain this hellish uptick. Without missing a beat, they bemoan the stigma holding troops back from seeking mental health help, or the fatal decisions of young men and women made while self-medicating with drugs and alcohol.

What about the medication decisions the military makes?

Consider this: The same psychotropic medications the Defense Department is handing out by the millions contain “black box” warnings about suicidal thoughts that the drugs can instill in those up to age 24. Recruits’ average age is 19 or 20.

In March, I asked Col. David Sutherland, director of Warrior and Family Support and special assistant to Joint Chiefs Chairman Adm. Mike Mullen, why the military relies so heavily on medications when counseling is more effective and comes without the side effects of addiction and potential suicide.

“Because it’s easier,” Sutherland said.

More recently, Dewleen Baker, a PTSD expert at the VA San Diego Healthcare System, said that “pharmacological treatments are poorer than verbal” treatments.

The Defense Department was asked to comment on its medication program and how Risperdal and other antipsychotics used to treat PTSD became so widely prescribed when they do not work. I have yet to hear back.

About the Author: San Diego-based journalist and columnist Rick Rogers has covered military and veterans’ issues for 25 years at newspapers both stateside and overseas, including a stint at Pacific Stars Stripes while a sergeant in the Army. Besides writing on defense and veterans’ issues, he also hosts the only military talk radio show in Southern California. ”Front and Center: Military Talk Radio” airs Fridays at 11 a.m. to noon PST on KCEO-AM 1000. Podcasts are available at Contact him at 760-445-3882 or [email protected].

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