The Army Kills Its Own:

“At Least One In Six Service Members Is On Some Form Of Psychiatric Drug”

“Some Double The Risk For Suicide”

“As The Number Of Medications Goes Up, The Probability Of Adverse Events Like Hospitalization Or Death Goes Up Exponentially”

“There Is Overwhelming Evidence That The Newer Antidepressants Commonly Prescribed By The Military Can Cause Or Worsen Suicidality, Aggression And Other Dangerous Mental States”

 

 

Doctors — and, more recently, lawmakers — are questioning whether the drugs could be responsible for the spike in military suicides during the past several years, an upward trend that roughly parallels the rise in psychiatric drug use.

 He cited dozens of clinical studies conducted by drug companies and submitted to federal regulators, including one among veterans that showed “completed suicide rates were approximately twice the base rate following antidepressant starts in VA clinical settings.”

March 8, 2010 By Andrew Tilghman and Brendan McGarry, Army Times [Excerpts]

At least one in six service members is on some form of psychiatric drug.

And many troops are taking more than one kind, mixing several pills in daily “cocktails” — for example, an antidepressant with an antipsychotic to prevent nightmares, plus an anti-epileptic to reduce headaches — despite minimal clinical research testing such combinations.

The drugs come with serious side effects: They can impair motor skills, reduce reaction times and generally make a war fighter less effective. Some double the risk for suicide, prompting doctors — and Congress — to question whether these drugs are connected to the rising rate of military suicides.

“It’s really a large-scale experiment. We are experimenting with changing people’s cognition and behavior,” said Dr. Grace Jackson, a former Navy psychiatrist.

A Military Times investigation of electronic records obtained from the Defense Logistics Agency shows DLA spent $1.1 billion on common psychiatric and pain medications from 2001 to 2009.

It also shows that use of psychiatric medications has increased dramatically — about 76 percent overall, with some drug types more than doubling — since the start of the current wars.

Troops and military health care providers also told Military Times that these medications are being prescribed, consumed, shared and traded in combat zones — despite some restrictions on the deployment of troops using those drugs.

The investigation also shows that drugs originally developed to treat bipolar disorder and schizophrenia are now commonly used to treat symptoms of post-traumatic stress disorder, such as headaches, nightmares, nervousness and fits of anger.

But experts say the lack of proof that these treatments work for other purposes, without fully understanding side effects, raises serious concerns about whether the treatments are safe and effective.

 The DLA records detail the range of drugs being prescribed to the military community and the spending on them:

Antidepressants and anticonvulsants are the most common mental health medications prescribed to service members. Seventeen percent of the active duty force, and as much as 6 percent of deployed troops, are on antidepressants, Brig. Gen. Loree Sutton, the Army’s highest-ranking psychiatrist, told Congress on Feb. 24.

 

Many of the newest psychiatric drugs come with strong warnings about an increased risk for suicide, suicidal behavior and suicidal thoughts.

Doctors — and, more recently, lawmakers — are questioning whether the drugs could be responsible for the spike in military suicides during the past several years, an upward trend that roughly parallels the rise in psychiatric drug use.

 

From 2001 to 2009, the Army’s suicide rate increased more than 150 percent, from 9 per 100,000 soldiers to 23 per 100,000. The Marine Corps suicide rate is up about 50 percent, from 16.7 per 100,000 Marines in 2001 to 24 per 100,000 last year. Orders for psychiatric drugs in the analysis rose 76 percent over the same period.

 

“There is overwhelming evidence that the newer antidepressants commonly prescribed by the military can cause or worsen suicidality, aggression and other dangerous mental states,” said Dr. Peter Breggin, a psychiatrist who testified at the same Feb. 24 congressional hearing at which Sutton appeared.

Other side effects — increased irritability, aggressiveness and hostility — also could pose a risk.

 “Imagine causing that in men and women who are heavily armed and under a great deal of stress,” Breggin said. He cited dozens of clinical studies conducted by drug companies and submitted to federal regulators, including one among veterans that showed “completed suicide rates were approximately twice the base rate following antidepressant starts in VA clinical settings.”

 

Defense officials repeatedly have denied requests by Military Times for copies of autopsy reports that would show the prevalence of such drugs in suicide toxicology reports.

Spc. Mike Kern enlisted in 2006 and spent a year deployed in 2008 with the 4th Infantry Division as an armor crewman, running patrols out of southwest Baghdad. Kern went to the mental health clinic suffering from nervousness, sleep problems and depression. He was given Paxil, an antidepressant that carries a warning label about increased risk for suicide.

 

A few days later, while patrolling the streets in the gunner’s turret of a Humvee, he said he began having serious thoughts of suicide for the first time in his life.

“I had three weapons: a pistol, my rifle and a machine gun,” Kern said. “I started to think, ‘I could just do this and then it’s over.’ That’s where my brain was: ‘I can just put this gun right here and pull the trigger and I’m done. All my problems will be gone.’”

Kern said the incident scared him, and he did not take any more drugs during that deployment.  But since his return, he has been diagnosed with PTSD and currently takes a variety of psychotropic medications.

Other side effects cited by troops who used such drugs in the war zones include slowed reaction times, impaired motor skills, and attention and memory problems.

One 35-year-old Army sergeant first class said he was prescribed the anticonvulsant Topamax to prevent the onset of debilitating migraines.  But the drug left him feeling mentally sluggish, and he stopped taking it.

“Some people call it ‘Stupamax’ because it makes you stupid,” said the sergeant, who asked not to be identified because he said using such medication carries a social stigma in the military.

 

Being slow — or even “stupid” — might not be a critical problem for some civilians. But it can be deadly for troops working with weapons or patrolling dangerous areas in a war zone, said Dr. John Newcomer, a psychiatry professor at Washington University in St. Louis and a former fellow at the American Psychiatric Association. Little hard research has been done on such unique aspects of psychiatric drug usage in the military, particularly off-label usage.

A 2009 VA study found that 60 percent of veterans receiving antipsychotics were taking them for problems for which the drugs are not officially approved.

For example, only two are approved for treating PTSD — Paxil and Zoloft, according to the Food and Drug Administration.

But in actuality, doctors prescribe a range of drugs to treat PTSD symptoms.

To win FDA approval, drug makers must prove efficacy through rigorous and costly clinical trials. But approval determines only how a drug can be marketed; once a drug is approved for sale, doctors legally can prescribe it for any reason they feel appropriate.

Such off-label use comes with some risk, experts say.

“Patients may be exposed to drugs that have problematic side effects without deriving any benefit,” said Dr. Robert Rosenheck, a professor of psychiatry at Yale University who studied off-label drug use among veterans. “We just don’t know. There haven’t been very many studies.” Some military psychiatrists are reluctant to prescribe off-label.

Combinations of drugs pose another risk.

Doctors note that most drugs are tested as a single treatment, not as one ingredient in a mixture of medications.

“In the case of poly-drug use – the ‘cocktail’ — where you are combining an antidepressant, an anticonvulsant, an antipsychotic, and maybe a stimulant to keep this guy awake — that has never been tested,” Breggin said.

 Newcomer agreedi style="mso-bidi-font-style:normal">. “When we go to the literature and try to find support for these complex cocktails, we’re not going to find it,” he said.

“As the number of medications goes up, the probability of adverse events like hospitalization or death goes up exponentially.”

Dr. Harry Holloway, a retired Army colonel and a psychiatry professor at the Uniformed Ser­vices University of the Health Sciences in Bethesda, Md., said the increased use of these medications is simply another sign of deployment stress on the force.

“For a long time, the ops tempo has been completely unrelieved and unrestrained,” Holloway said.

“When you have an increased ops tempo, and you have certain scheduling that will make it hard for everyone, you will produce a more symptomatic force.”

 

“The Pentagon Issued A Rule Barring Troops Who Were Taking Some Drugs From Deploying To A Combat Zone”o>

“Drugs Specifically Mentioned In The Policy Are, In Fact, Making Their Way To The War Zones”

“Any Soldier Can Deploy On Anything,” Said Capt. Maria Kimble:

““A Psychiatrist and Former Navy Lieutenant Commander Resigned Her Commission because She Was Uncomfortable With The Military’s Heavy And Growing Use Of Psychotropic Drugs”

 

He said he’s tried to wean himself off the psychiatric medications he began taking a few years ago.

 “I was a zombie; I couldn’t remember my kids’ names,” he said.

March 8, 2010 By Andrew Tilghman, Army Times [Excerpts]

Sgt. Chuck Luther wasn’t on any psychotropic drugs when he deployed to Iraq in October 2006, settling in at Camp Taji with the 1st Cavalry Division during the war’s darkest days, shortly before the surge began.

 But after a few months, he was shaken by the deaths in his unit.

“I started having nightmares … having to go and pick up the body bags at the gate and deliver them to the mortuary affairs units; night­mares about getting killed, getting blown up,” Luther recalled.

He told his command he was depressed, angry and having trou­ble sleeping. They sent him to a social worker who suggested he begin taking psychotropic drugs. But the social worker, a lieutenant colonel, lacked the legal authority to prescribe such drugs.

“He sent me to a captain, a psychiatrist who could actually prescribe medicine,” Luther said. “We had five minutes of face time.  We call it ‘checking the box’ in the military.”

“He says, ‘I heard you’re having thoughts of suicide, I hear you’re having anger. We’re going to try this. Just go over to the pharmacy and pick it up.’ ” Luther returned to his trailer that night with four bottles of pills: Selexa, an antidepressant; Seroquel, an antipsychotic; Ambien, sleeping pills; and the anti­anxiety drug Valium.

In late 2006, the Pentagon issued a rule barring troops who were taking some drugs from deploying to a combat zone. They include “antipsychotics used to treat bipolar and chronic insomnia symptoms; lithium and anticonvulsants used to control bipolar symptoms.”

The rule came in response to a congressional mandate to tighten mental health screening for deployed troops.

Doctors say they help ensure that troops can handle the demands of deployment while also having access to the medical supervision and follow-up care these drugs can require.

But the rules are ambiguous; drugs specifically mentioned in the policy are, in fact, making their way to the war zones, according to deployed troop data maintained by Tricare.

“Any soldier can deploy on anything,” said Capt. Maria Kimble, an Army reservist and clinical social worker who served as the primary behavioral health officer for brigade combat teams in Iraq and Afghanistan.

“It’s always kind of subjective. If they really want someone to deploy, they can always find a loophole.”

The quantities of these heavy psychiatric medications going downrange is unclear. Officials at Tricare and the Defense Logistics Agency say they do not have comprehensive estimates for the quantity and type of drugs heading specifically into the war zones.

One Tricare official said some drug shipments to clinics in U.S. Central Command, which oversees the Iraq and Afghanistan war zones, “fall into a black hole.”

Another official, Rear Adm. Tom McGuiness, chief pharmacy officer for Tricare, acknowledged in an interview that “the records aren’t great in the forward units.”

Tricare’s estimates on drugs provided to deploying troops appear to show some quantities of antipsychotics and anticonvulsants are being issued to troops heading overseas.

About 89,000 antipsychotic pills and 578,000 anticonvulsant pills were prescribed and provided to deploying troops in 2008, according to Tricare data provided to Military Times.

Military studies have estimated that from 5 percent to 17 percent of troops in the war zones from 2007 to 2009 were taking medications for mental health problems or combat stress.

Anecdotally, the numbers may be far higher. Kimble, the Army social worker, put the figure at upwards of 50 percent in some individual units.

Many military psychiatrists acknowledge that the use of mental health drugs is uniquely complex in military medicine, especially in combat zones.

Military physicians must consider not only the health of the individual patients, but also their duty to the mission, said Grace Jackson, a psychiatrist and former Navy lieutenant commander who resigned her commission in 2002 because she was uncomfortable with the military’s heavy and growing use of psychotropic drugs.

“There has always been an added complication with military medicine,” Jackson said. “The physician in uniform takes two oaths — an oath to serve the patient and an oath to serve the nation, commander in chief and the larger military. Where do you draw the line between performance enhancement and the treatment of pathology?”

The issue of psychiatric drug use in the war zones has begun to attract attention on Capitol Hill.

Luther said drug use was common among troops he served with, and many passed around these controlled substances — technically a crime under state and federal law — just like any other piece of essential gear shared among a tightly knit unit.

“We didn’t just share MREs and water; we shared Ambien, too,” Luther said. “One time another soldier said, ‘Hey, I’m running out of my Ambien and I can’t get it until I get back to refit our truck in a few days.’ I said, ‘Sure, I can help you out, as long as you get me back when you refill.’ ”

 

Luther was separated from the Army because doctors said he had a “personality disorder” — essentially they blamed his problems on a pre-existing condition rather than on his combat experience.span>

 

TheThese days, Luther lives near Fort Hood, where he has a job driving a truck delivering snack food.

He believes he was improperly discharged and has been fighting the Army’s medical determination.

He said he’s tried to wean himself off the psychiatric medications he began taking a few years ago.

“I was a zombie; I couldn’t remember my kids’ names,” he said.

But even now, he remains on two daily medications — zodone, an antidepressant, and Buspar, typically used as an anti-­anxiety drug.

 

They were prescribed by VA doctors.