REPORT: DoD-VA Spent $134 Million on Antipsychotic Seroquel From 2003-2009

Military doctors issued 54,581 prescriptions for Seroquel alone in 2011, 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 from a Military Times Freedom of Information Act request. Critics of VA and the DoD’s mental health care policies say troops and veterans needing counseling are instead heavily medicated as the preferred therapeutic solution — often for PTSD — due to severe staff shortages of mental health care providers within DoD and VA. (Bloomberg)

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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http://www.pharmalot.com/2012/06/the-us-military-and-off-label-antipsychotic-use/

Soldiers, Veterans, PTSD and Antipsychotic Drugs

Soldiers, Veterans, PTSD and Antipsychotic Drugs

Philly.com, May 14, 2012

The nation has a huge challenge and obligation regarding the soldiers and airmen, Marines and sailors, who are lucky enough to come home alive from Iraq and Afghanistan.

Battlefield medics and medicine, in-country surgeons and speedy airlift to hospitals in Germany and then the United States all contribute to service members surviving physical wounds that would have meant death in previous wars.

However, the psychological injuries, including post-traumatic stress disorder (PTSD), can also be severe and are often not as identifiable as a broken bone.

“As the tide of war recedes, we have the opportunity, and the responsibility, to anticipate the needs of returning Veterans,” Secretary of Veterans Affairs Eric K. Shinseki said in April.

“History shows that the costs of war will continue to grow for a decade or more after the operational missions in Iraq and Afghanistan have ended. As more veterans return home, we must ensure that all veterans have access to quality mental health care.”

Shinseki’s comments came as the VA announced it was hiring about 1900 psychiatrists, psychologists, social workers and support staff to help in the existing mental health staff of 20,590.

How pharmaceuticals – specifically, antipsychotic drugs – fit into treatment are part of the discussion.

In the last few weeks, the Pentagon has started to tighten the limits on antipsychotics use.

On Feb. 22, Assistant Secretary of Defense Dr. Jonathan Woodson sent a memo on PTSD to all branches of the military, expressing that “the greatest concern is the suspicion of the over-prescription of antipsychotic medications for PTSD.”

Sunday’s Inquirer story on the topic is here.

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http://www.philly.com/philly/blogs/phillypharma/Soldiers-veterans-PTSD-and-antipsychotic-drugs.html

More Than 300 Soldier Deaths Due to Drug Toxicity Since 2006, Many Linked to PTSD Medications Army Reports

Army Warns Doctors Against Using Certain Drugs in PTSD Treatment

by Bob Brewin
NextGov, April 25, 2012

This is the 16th story in an ongoing series.

The Army Surgeon General’s office is backing away from its long-standing endorsement of prescribing troops multiple highly addictive psychotropic drugs for the treatment of post-traumatic stress disorder and early this month warned regional medical commanders against using tranquilizers such as Xanax and Valium to treat PTSD.

PFC Timothy R. Alderman, Fort Carson soldier did 250 combat missions and had 16 confirmed kills during 2006 tour in Ramadi, Iraq. He also pulled the body of his platoon sergeant from the aftermath of an IED blast. Alderman died Oct. 20, 2008 from overdose after Army doctors prescribed him a dangerous cocktail of drugs for PTSD symptoms.

An April 10 policy memo that the Army Medical Command released regarding the diagnosis and treatment of PTSD said a class of drugs known as benzodiazepines, which include Xanax and Valium, could intensify rather than reduce combat stress symptoms and lead to addiction.

The memo, signed by Herbert Coley, civilian chief of staff of the Army Medical Command, also cautioned service clinicians against prescribing second-generation antipsychotic drugs, such as Seroquel and Risperidone, to combat PTSD.

The drugs originally were developed to treat severe mental conditions such as schizophrenia and bipolar disorder. The memo questioned the efficacy of this drug class in PTSD treatment and cautioned against their use due to potential long-term health effects, which include heart disorders, muscle spasms and weight gain.

Throughout more than a decade of war in Afghanistan and Iraq, the military services have relied heavily on prescription drugs to help troops deal with their mental health problems during and after deployment. In a June 2010 report, the Defense Department’s Pharmacoeconomic Center said 213,972, or 20 percent of the 1.1 million active-duty troops surveyed, were taking some form of psychotropic drug — antidepressants, antipsychotics, sedative hypnotics or other controlled substances.

The Army, in a July 2010 report on suicide prevention, said one-third of all active-duty military suicides involved prescription drugs.

Read the rest of this story:

http://www.nextgov.com/nextgov/ng_20120425_6330.php?oref=topstory

Read more stories from this series on mental health problems facing Afghanistan and Iraq veterans:

http://www.nextgov.com/defense/broken-warriors/55403/