2012 Issues   /   TBI

Potential Overuse of Antipsychotic Drugs for PTSD Patients is Under Review

USM By U.S. Medicine
September 6, 2012

By Annette M. Boyle

FORT DETRICK, MD — In the wake of a memo from Assistant Secretary of Defense Jonathan Woodson, MD, expressing concern about potential over-prescription of antipsychotic drugs for treatment of post-traumatic stress disorder, the Army and VA have launched an interagency research program to evaluate the effectiveness of several other medications to treat common PTSD symptoms.

“There is a real need to better understand the various medications currently being used off-label by providers to treat combat-related PTSD,” Maj. Gary H. Wynn, research psychiatrist with the Neurotrauma and Psychological Health Project Management Office at the U.S. Army Medical Materiel Development Activity (USMMDA) told U.S. Medicine.

An expert panel of researchers and providers from the DoD, VA, academia and civilian sectors determined that, “the most pressing need was better understanding of the treatments for sleep problems associated with combat-related PTSD,” Wynn said.

Army Research Psychiatrist Maj. Gary Wynn, Center for Military Psychiatry and Neuroscience at Walter Reed Army Institute of Research, speaks to fellow psychiatrists at the American Psychiatric Association Annual Meeting this year.

Woodson’s memo to the assistant secretaries of all military branches noted that the use of atypical or second-generation antipsychotics had increased from 0.1% to 1.0% servicewide from 2002 to 2009, driven in large part by the off-label use of these medications to treat sleep dysfunction and irritability or anger. According to the memo, “Seroquel, an atypical antipsychotic, was prescribed to 1.4% of Army [servicemembers]SMs and 0.7% of Marines in Fiscal Year 2010.”

Col. Carol W. Labadie, PharmD, U.S. Army Pharmacy Consultant/Pharmacy Program Manager for the Army Surgeon General, questioned the specific numbers in the memo but concurred that the number of prescriptions for antipsychotics has been rising significantly. She told U.S.Medicine that about 1% of all soldiers were prescribed antipsychotics in 2010.

“Seroquel accounted for about 0.4%, with all other antipsychotics about 0.8%, but the trend has definitely been going up,” Labadie noted.

Difficulty sleeping is a primary symptom of PTSD and a common side effect of the two drugs that are approved by the Food and Drug Administration for the treatment of the disorder, sertraline (Zoloft) and paroxetine (Paxil), said Labadie. Antipsychotics such as Seroquel and resperidone may cause sleepiness in some patients, which has led to their use in treating this troubling aspect of PTSD.

A memo from Army Chief of Staff Herbert A. Coley, however, cautioned health-care providers in April that use of atypical antipsychotics raises “numerous concerns with potential long-term adverse health effects (e.g., weight gain, glucose dysregulation, cardiac effects, extrapyramidal effects), and these medications have shown disappointing results in clinical trials in the treatment of PTSD. Risperidone specifically has been given a D-level recommendation in the VA/DoD CPG (harm outweighs benefits) based on the results of a large multicenter VA cooperative study.”

The same memo also advised providers that, “although benzodiazepines have frequently been used ‘as needed’ and continuously for anxiety disorders, including to augment evidence-based treatment modalities in PTSD, there is evidence to suggest that benzodiazepines may actually potentiate the acquisition of fear responses and worsen recovery from trauma.” In addition, the high rate of comorbid alcohol misuse and substance-use disorders and difficulty discontinuing the drugs contraindicate use of benzodiazepines in patients with PTSD, it said.

Related Articles

Despite Overall Longevity Trends, Mortality Increases for Schizophrenia Patients

Since the 1970s, mortality rates have declined, extending average lifespan by almost a decade.

Nightmare Disorder Increases Mental Health Risks in Servicemembers

Lack of sleep has long been a feature of military service.

U.S. Medicine Recommends

More From department of defense dod

Department of Defense (DoD)

High Rate of Pectoralis Tears Among Deployed Servicemembers Lifting Weights

Lifting weights is one way servicemembers keep in peak physical condition during deployment.

Department of Defense (DoD)

DoD Study Finds That Type 2 Diabetes Increases Breast Cancer Mortality

Having Type 2 diabetes mellitus (DM-2) increases mortality risk in breast cancer patients, regardless of whether diabetes was diagnosed before or after breast cancer, according to a recent study.

Department of Defense (DoD)

Now Hear This: Otolaryngologist Leads Effort to Prevent Auditory Issues

Among those who are exposed to combat, it’s the weapons fire that does it. In the Navy, it’s the noise levels in engine rooms and on the decks of carriers.

Department of Defense (DoD)

GAO: ‘Gaps’ in MHS Physician Specialties Could Affect Wartime Readiness

WASHINGTON — The military services need to develop “targeted and coordinated strategies” to alleviate military physician gaps, a recent report recommended.

Department of Veterans Affairs (VA)

VA Vows to Meet Deadline for Revamp of Veteran Claims Appeal Process

WASHINGTON—VA has told legislators that the agency is on track with a new law that will give veterans more options to have their claims appeals reviewed.

Facebook Comment

Subscribe to U.S. Medicine Print Magazine

U.S. Medicine is mailed free each month to physicians, pharmacists, nurse practitioners, physician assistants and administrators working for Veterans Affairs, Department of Defense and U.S. Public Health Service.

Subscribe Now

Receive Our Email Newsletter

Stay informed about federal medical news, clinical updates and reports on government topics for the federal healthcare professional.

Sign Up