One of the most disturbing trends within our military population is the increased incidence of suicide. More of our personnel died from suicide than from military action in 2012. This source provides recent data.
Note that the number of suicides has been increasing while the number of soldiers involved in military action has been decreasing.
Richard A. Friedman, director of the psychopharmacology clinic at the Weill Cornell Medical College, provided an article in the New York Times that notes the suicide issue and proceeds to accuse the Armed Services of misusing psychoactive drugs in an attempt to counter the results of stress experienced by soldiers.
"The prescribing trends suggest that the military often uses medications in ways that are not approved by the Food and Drug Administration [FDA] and do not comport with the usual psychiatric standards of practice."
Friedman points out that the military is supposed to carefully assess recruits and weed out those who might have psychological problems. Therefore one should expect less need for psychoactive drugs than exists in the general population. That is definitely not the case.
This experimental use of drugs on the soldiers is troubling to Friedman.
Friedman uses treatment of post-traumatic stress disorder (PTSD) to illustrate the issues associated with these practices.
"In treating soldiers who have PTSD symptoms with antipsychotic medications, the military is violating its own treatment guidelines, which clearly state that S.S.R.I. antidepressants are the preferred first line of treatment for PTSD. The military medical leadership has, in fact, expressed concern about prescribing trends. In February 2012, the assistant secretary of defense for health affairs, Dr. Jonathan Woodson, wrote in a memo to the military’s leadership that the ‘greatest concern is the suspicion of the over-prescription of antipsychotic medications for PTSD’."
Dr. Woodson is correct in being concerned.
"There are other disturbing prescription trends in the military. The number of prescriptions written for potentially habit-forming anti-anxiety medications — like Valium and Klonopin — rose 713 percent between 2005 and 2011. The use of sedating anticonvulsants — Topamax, Neurontin and Lyrica — increased 996 percent during this period. (Prescriptions for these three drugs increased 94 percent during the same period in the civilian population.)"
"None of these anticonvulsants are F.D.A.-approved for psychiatric use and none are without risk: anticonvulsants can impair short-term memory and fine-motor coordination, which would adversely affect combat performance."
Friedman is careful not to directly accuse the military doctors of unethical behavior, but he cannot help but issue these comments:
"There is an analogy, perhaps, between the military’s use of psychoactive drugs and the practice of pumping athletes full of steroids so they can continue to compete despite physical pain; athletes — and also soldiers — whose performance is chemically enhanced in this way may, however, unwittingly sustain more serious injuries as a result."
An article by Martha Rosenberg is less kind in evaluating the military and its drug prescribing practices. She points out that many of the drugs being discussed are known to increase the probability of suicidal behavior.
"The pills and pill cocktails many troops are prescribed are clearly linked to suicidal thoughts and behavior. Antidepressants like Prozac and Paxil, antipsychotics like Seroquel and Zyprexa and anti-seizure drugs like Lyrica and Neurontin all carry clear suicide warnings and all are widely used in the military. Almost 5,000 newspaper reports link antidepressants to suicide, homicide and bizarre behavior on the website SSRIstories.com. The malaria drug Lariam is also highly correlated with suicide and its use actually increased in the Navy and Marine Corps in 2011, according to the Associated Press."
David Healy is a psychopharmacologist who occasionally arouses the ire of his colleagues by dredging up inconvenient historical data. He looked up suicide rates for schizophrenic patients before the age of medicinal treatment (1875-1924) and compared them to the rates that exist when current medications are used (1994-1998). He concluded that the use of modern antipsychotic medications—the ones being prescribed to our soldiers—increased the suicide rate among schizophrenics by a factor of 20.
Rosenberg seems to have a point.
Rosenberg takes yet another step and raises the issue of unethical behavior.
If this statement strikes the reader as a bizarre dip into a conspiracy theory, the reader should remember that conspiracy theories are popular because, occasionally, conspiracies actually exist.
Let us turn now for some insight to Ben Goldacre and his book: Bad Pharma: How Drug Companies Mislead Doctors and Harm Patients.
Drug companies do wondrous things at times, but in the field of interest here, mental illness, there is little science to go on, and what exists is mostly created by the drug companies themselves. That is a situation reeking with potential ethical issues.