The US Military and Off-Label Antipsychotic Use
by Ed Silverman
Pharmalot.com, June 14, 2012
For the past several years, a curious trend has occurred in the US military – a growing number of service members have been regularly prescribed popular antipsychotics, which are approved to treat schizophrenia and bipolar disorder, for various off-label uses, notably insomnia and post-traumatic stress disorder.
From 2002 to 2009, prescribing rose tenfold, according to a February memo from US Assistant Secretary of Defense Jonathan Woodson.
At the same time, antidepressant prescribing had barely changed, even though some antipsychotics can be used as adjunct therapy for treating depression.
One US Army official last fall speculated to Psychiatric News that antipsychotics may have been preferable to other drugs that can cause addiction, such as benzodiazepines, or widely prescribed sleeping pills, such as Ambien, that have been linked to sleepwalking.
But growing concern over links between antipsychotics – especially Seroquel, which is the most widely prescribed antipscyhotic by the US military – and irregular heartbeats is prompting moves to restrict usage.
Service members were diagnosed with insomnia at a rate of 30 per 10,000. By 2009, the rate had jumped to 226 per 10,000. Prescriptions for Seroquel rose 27-fold in the same time period. And according to The Associated Press, in 2009, the Pentagon spent $8.6 million on the drug, while the Veterans Affairs Department spent $125.4 million.
For instance, a retrospective review of 692 patients who were prescribed Seroquel at the Madigan Army Medical Center in 2007 and 2008 found that only 3.4 percent received the drug for an approved use, which would also include adjunct treatment for depression.
However, 60 percent received the drug for insomnia, 19 percent for anxiety, 12 percent for mood disorders and 8 percent for post-traumatic stress disorder.
Yet, only 18 percent were screened for irregular heartbeats and 126 underwent an EKG, with 11 percent showing abnormal heart rhythms, according to a presentation at the American Academy of Sleep Medicine annual meeting (here is the presentation – see page A179).
Such findings underscore the concerns. Last year, the armed services issued 54,581 prescriptions for Seroquel alone, the most for any antipsychotic — and more than 2.5 times the number of prescriptions for the second-most prescribed atypical antipsychotic, Abilify, and nearly four times the number for Risperdal, according to information obtained by Military Times under a Freedom of Information Act request.
In 2003, Military Times reports, service members were diagnosed with insomnia at a rate of 30 per 10,000. By 2009, the rate had jumped to 226 per 10,000. Prescriptions for Seroquel rose 27-fold in the same time period. And according to The Associated Press, in 2009, the Pentagon spent $8.6 million on the drug, while the Veterans Affairs Department spent $125.4 million.
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Filed under: Resources | Tagged: atypical antipsychotics, Joint Base Lewis-McChord, Madigan Army Medical Center, Military Times Report on antipsychotics, Overdose, PTSD, QT prolongation long QT irregular heartbeat sudden cardiac death, Risperdal Abilify, Seroquel, VA Veterans Affairs |