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PTSD meds don’t work but does the Army care? They need to keep troop strength up regardless of the severe damage to the mental health of the troops.

Military and Veterans Affairs Department physicians often prescribe medication to ease the symptoms of combat-related post-traumatic stress disorder, even though only two antidepressants — Paxil and Zoloft — are approved specifically by the Food and Drug Administration to treat the disorder. The Army is hoping to change this, launching a major research initiative next year on the effectiveness of commonly prescribed medications for PTSD.

The Army research will test commonly prescribed medications over the next several years at multiple sites with hundreds of service members and veterans.

“For pharmaceuticals that show benefits in treating combat-related PTSD, the Department of Defense may work toward a new indication or change in labeling,” Wynn said. Published results from the first trial are expected by 2016.

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.”

In the April issue of Current Psychiatry Online by Jolene Bostwick, clinical assistant professor of pharmacy at the University of Michigan College of Pharmacy. wrote “benzodiazepine administration fails to prevent PTSD and may increase its incidence.” She added, “use of benzodiazepines for PTSD is associated with withdrawal symptoms, more severe symptoms after discontinuation and possible disinhibition, and may interfere with patients’ efforts to integrate trauma experiences.”

An Army doctor who declined to be identified told Nextgov “these long-overdue policy changes are welcome, but they will further shift the mental health care of soldiers to an already overstressed VA and will result in the separation of many mentally stressed volunteers, who just months earlier had been counseled to steel themselves for a career of perpetual deployment and had been willing to sacrifice the best years of their lives to do so.”

Dr. Grace Jackson, a former Navy psychiatrist who resigned her commission in 2002 “because I did not want to be a pill pusher” said the new Army policy shows “they are finally admitting to some problems associated with at least one class of psychiatric medication.” But, Jackson said, the Army policy does not address problems with other classes of prescription drugs, including antidepressants and selective serotonin re-uptake inhibitors (SSRIs), such as Prozac, in the treatment of PTSD. Clinical studies, Jackson said, have shown these drugs to be no better than placebos — but far more dangerous in the treatment of PTSD.

Though the Army has adopted a new policy on the use of benzodiazepines, Jackson said the Defense Department overall is still wedded to a policy of using drugs to treat mental problems even when scientific evidence “demonstrates poor risk-benefit ratios.”

Jeff Eastman

jeffeastman@ptsdstress.com

ptsdstress.com

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Didn’t anyone care what drugs veterans were and are getting from the VA and the Army Medical Command? Now many vets are addicted. And homeless. And depressed. And suicidal. Shame on the VA and the Army.

Valium was introduced in 1960. Xanax in 1970. Prozac in 1988. That’s 24 to 52 years that information has been out there on the risks of these medications including addiction and side affects.
The Army Surgeon General’s office is backing away from its long-standing endorsement of anti-psychotic 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.

On April 10, the Army Medical Command released a memo regarding the diagnosis and treatment of PTSD and 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 anti-psychotic drugs 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.”

Mental health experts say the military’s prescription drug problem is exacerbated by a U.S. Central Command policy that dates to October 2001 and provides deploying troops with up to a 180-day supply of prescription drugs under its Central Nervous System formulary.

The Army’s new PTSD policy makes it clear that the risk of treating combat stress with benzodiazepines outweighs the rewards: “Benzodiazepine use should be considered relatively contraindicated in combat veterans with PTSD because of the high co-morbidity of combat-related PTSD with alcohol misuse and substance use disorders (up to 50 percent co-morbidity) and potential problems with tolerance and dependence.”

In the April issue of Current Psychiatry Online by Jolene Bostwick, clinical assistant professor of pharmacy at the University of Michigan College of Pharmacy. wrote “benzodiazepine administration fails to prevent PTSD and may increase its incidence.” She added, “use of benzodiazepines for PTSD is associated with withdrawal symptoms, more severe symptoms after discontinuation and possible disinhibition, and may interfere with patients’ efforts to integrate trauma experiences.”

An Army doctor who declined to be identified told Nextgov “these long-overdue policy changes are welcome, but they will further shift the mental health care of soldiers to an already overstressed VA and will result in the separation of many mentally stressed volunteers, who just months earlier had been counseled to steel themselves for a career of perpetual deployment and had been willing to sacrifice the best years of their lives to do so.”

Dr. Grace Jackson, a former Navy psychiatrist who resigned her commission in 2002 “because I did not want to be a pill pusher” said the new Army policy shows “they are finally admitting to some problems associated with at least one class of psychiatric medication.” But, Jackson said, the Army policy does not address problems with other classes of prescription drugs, including antidepressants and selective serotonin re-uptake inhibitors (SSRIs), such as Prozac, in the treatment of PTSD. Clinical studies, Jackson said, have shown these drugs to be no better than placebos — but far more dangerous in the treatment of PTSD.

Though the Army has adopted a new policy on the use of benzodiazepines, Jackson said the Defense Department overall is still wedded to a policy of using drugs to treat mental problems even when scientific evidence “demonstrates poor risk-benefit ratios.”

Jeff Eastman

jeffeastman@ptsdstress.com

www.ptsdstress.com

PTSD and the VA by the numbers. It’s a losing battle.

According to a recent Stanford study, over 35% of vets from Iraq and Afghanistan suffer from PTSD.  The VA serves a population of more than 7.8 million veterans, providing inpatient care to about 600,000 veterans and managing more than 57 million outpatient visits each year.

Approximately 2, 000, 000 soldiers have served in Iraq and Afghanistan. That makes about 700, 000 vets that suffer from PTSD and that does not include those that may have severe traumatic stress and other mental health issues like divorce, depression, and anxiety, not to mention drug and alcohol addiction. Add approximately 800,000 vets who served in Viet Nam, the youngest averaging approximately 57 years of age. Let’s add just 15% for potential PTSD from that group. It all adds up to about 1, 000,000 veterans from the last three wars suffering from PTSD.

Realistically, up to 40% of veterans will never see a therapist for reasons of accessibility, fear of professional and social stigma, and just the difficulty of getting to appointments, not to mention the frustration of having to wait months for an appointment with a therapist. No wonder there is so much overdosing of pain opiates. It’s a holding strategy.  That leaves about 600, 000 veterans who have PTSD and would like to get help.

The VA currently (2012) has a staff of 20, 271 mental health professionals.  As of April 1, 2011 the VA employed 3, 079 psychologists — about 5 percent of licensed psychologists in the United States.  That’s down from 3361 in 2010.  That means that every psychologist (those with the most training with either Master’s degrees or PhD’s) must average about 200 potential patients per year with a recommended average of 10 sessions of talk therapy per year per patient to reach the 600, 000 that need and will seek help if it is readily available. That also assumes that these psychologists are clinicians who see and talk to patients and are not just doing research.

That’s 2,000 sessions (a session is about 45 minutes plus 15 minutes for administrative) per year.   And that is only for PTSD and, to repeat, does not include those veterans with severe traumatic stress and other mental health issues like divorce, depression and anxiety, not to mention drug and alcohol addiction that.  A busy private therapist might see 5 patients per day or 25 per week or 1200 sessions per year.  With that kind of workload,  the VA is about 2000 psychologists short and they are having trouble keeping the ones they have. Many VA psychologists use their service as a training period and than move into private practice.

Here’s what the VA has to say. “VA is taking action to provide more mental health services for our nation’s veterans, especially for those who have recently returned from combat,” said VA Secretary James B. Peake. “By expanding our budget and training programs for psychologists within VA, we will be able to make enhancements to the world-class mental health services we already provide.  Not only will this initiative meet our short- term hiring needs, but it will also guarantee that VA has a pool of well-trained psychologists in the future.”

However, John Daigh, MD, assistant inspector general for healthcare inspections, said he repeatedly sees gaps in VA’s delivery of mental-health care services. One major gap is access to mental-health specialists — psychiatrists, psychologists, and, Daigh pointedly added, pain-management experts. “One of the factors that complicated the problem was that there was inadequate mental-health staffing.”
In Atlanta, VAMC had staffing shortages in most areas that would impact patient care. Positions for physicians, physician assistants and nurse practitioners were 73% filled, social workers were 65% filled, psychiatrists were 68% filled and psychologists were 45% filled.

VA facilities tend to have patients first see lower-level providers instead of the psychiatrists or psychologists best able to help them, according to Daigh. He said it can take considerable time for them eventually to be passed up the chain until they get to the specialists they need.

Despite adding billions of dollars for mental health care to Department of Veterans Affairs budgets the last four years, and the hiring of 7000 more mental health professionals at VA clinics and hospitals, many veterans with severe combat-related stress still face long waits to get the care they need.
And some VA facilities are “gaming” appointment dates so they appear to comply with a rule that veterans with post-traumatic stress disorder, or PTSD, begin treatment within 14 days of seeking care.

This year, the most disturbing testimony came from Michelle Washington, coordinator of PTSD services and evidence-based psychotherapy at the VA medical center in Wilmington, Del. She said staff shortages are impacting patient care as needed therapy for severe PTSD cases gets delayed by weeks or months, and scheduled appointments are sacrificed to management’s higher goal of boosting new patient enrollment figures. Patients wait as long as six weeks for their first appointment. While waiting, some patients lose their motivation for treatment while others see their PTSD worsen. Forty percent of providers said they could not schedule an appointment in their clinic within the VA-mandated 14-day window and 70 percent said they did not have adequate staff or space to deliver timely care.

“Also, because scheduling clerks are under great pressure to bring new veterans in within 14 days, they may take one of my PTSD patient’s regular appointments for a new patient appointment, which hurts the effectiveness of my patient’s treatment,” said Washington.

“As long as scheduling continues to be driven by clerks pressured by management to make the numbers look good, and as long as mental health providers have little or no say about where and when to best serve their patients,” Washington said, “this will keep happening.”

She also described a “pervasive shortage of primary care providers” that results in patients being referred erroneously to mental health care for lack of an initial comprehensive care assessment to diagnosis properly conditions that require medical care and not a mental health provider.

John Roberts, executive vice president for mental health at the Wounded Warrior Project, said many veterans still can’t get timely mental health appointments because staff hires aren’t keeping pace with the needs of veterans, particularly those returning from Iraq and Afghanistan.

“Why, after 10 years, do warriors have to struggle to get effective care for the signature wound in this war,” Roberts asked. “Why isn’t the under secretary for health…moving beyond measuring baseline access to initial mental health evaluations to systematically tracking access to sustained follow up care? If leaders spent more time speaking with the veterans, and their own clinicians, they would realize that the problems with VA mental health system run far deeper than even their data suggests.”

There are a lot of hardworking, caring mental health professionals at the VA. There just aren’t enough and there never will be at the rate Congress funds the VA. What the VA needs is to leverage new computer delivered therapies as a first line in addressing PTSD much like Great Britain does with their online Cognitive Behavior Therapy computer program. Programs like PTSDSTRESS.COM have shown great promise in alleviating symptoms caused by PTSD and they can be delivered anywhere, anytime, and at a fraction of the cost of traditional in-person therapies. Great therapists can do great work. There just will never be enough of them in the VA. axxzz

Jeff Eastman

jeffeastman@ptsdstress.com

ptsdstress.com

Thinking of suicide? The DoD/VA says “your chat session may be monitored.”

The DoD/VA Suicide Outreach at suicideoutreach.org has a live chat session offered by the Defense Center of Excellence Outreach Center. You must check off a release to use the chat. And they ask you to enter a phone number where you can be reached. Nobody there? Live chat?

And there is this in the release…”Your chat session may be monitored.”

They really don’t get it.

Jeff Eastman

jeffeastman@ptsdstress.com

PTSDSTRESS.COM

Hire a vet in 2012. Nothing’s changed since 1945.

Some employers are wary of hiring veterans because of potential mental health issues.
Nearly half of employers — 46 percent — said PTSD or other mental health issues were challenges in hiring employees with military experience, according to a 2010 Society of Human Resource Management survey. And a 2011 survey of 831 hiring managers by the Apollo Research Institute found that 39 percent were “less favorable” toward hiring military personnel when considering war-related psychological disorders.

About 20 percent of Iraq or Afghanistan veterans will develop post-traumatic stress disorder (PTSD), an anxiety disorder brought on by living through extremely stressful or life-threatening events; the more tours of duty, the greater the risk of PTSD. It can be devastating if untreated and lead to depression, panic attacks and drug abuse, and can increase the risk of suicide. Veterans commit one in five of all suicides in the U.S.

Yet recent high-profile news about veteran violence and its possible links to PTSD may speak louder than realities of the illness. It’s treatable, rarely leads to violent acts and is not uncommon — six to eight percent of Americans will develop PTSD in their lifetime.

“In the first place, most veterans do not develop PTSD. The minority that do have the same kinds of reactions of people exposed to a hurricane or a car accident,” says Josef Ruzek, Ph.D., director of the dissemination and training division at the National Center for PTSD.

Finding a civilian job can already by a hurdle, particularly for Iraq-war era vets. Unemployment rates have been consistently higher for this group than non-civilians of the same ages.  According to a recent report by the Department of Veterans Affairs, male veterans ages 18 to 24 who have served since September of 2001 have an unemployment rate of just over 29 percent, compared 17.6 percent of nonveterans of the same ages.  

Jeff Eastman

jeffeastman@ptsdstress.com

 

PTSDSTRESS.COM

 

To paraphrase Shakespeare, “First thing we do, is drug all the veterans.”

According to the Journal of the American Medical Association researchers studied a group of more than 140,000 U.S. military veterans who had served in Iraq and Afghanistan between 2005 and 2010, and who had been prescribed an opioid — a narcotic — within a year of getting a pain diagnosis at a veterans’ hospital.

“Veterans who had a mental health diagnosis, but particularly PTSD (post-traumatic stress disorder) were far more likely than their counterparts without mental health problems to receive opiate pain medication,” according to the study. Veterans with PTSD were 2 1/2 times more likely to be on these narcotics.  The researchers also were also concerned about the quantity of drugs prescribed.

Many of the veterans on these drugs — whether they were mentally ill or not — had higher rates of accidents, alcoholism, violent injuries, suicides and overdoses.  Findings demonstrate that alternative methods of treatment, such as physical therapy, talk therapy or acupuncture, should be offered more widely. And this is the AMA, one of the most conservative medical organizations out there.

The VA needs to explore the internet and computer theapies for PTSD like PTSDSTRESS.COM that are being developed but have so far refused to even consider anything other than cognitive behavior therapy, exposure therapy, and ineffective anti-depressants and opiates.

Can you imagine, in the current system, what is going to happen when a 1,000,0000  more veterans comes into the system in the next 5 years? You think there’s a problem now? You ain’t seen nothing yet.

Jeff Eastman

jeffeastman@ptsdstress.com

 

PTSDSTRESS.COM

 

In the last 80 minutes, a veteran committed suicide. The clock keeps ticking.

Veterans from Iraq and Afghanistan commit suicide at the rate of one every 80 minutes. 6500 veterans suicides are logged in every year and that doesn’t include those that die by reckless behavior, and overdose. And the VA says it has improved. To what?

More veterans are killed each year than the total number of soldiers killed in Iraq and Afghanistan since those wars began. During the civil war, 110, 100 Union and 94,00 Confederate soldiers were killed in action or mortally wounded. 388,000 died of disease.  391 Union soldiers soldiers died of suicide. The number of Confederate suicide has not been determined.

“It’s an epidemic that is not being addressed fully,” according to  Bob Filner, a Democratic congressman from San Diego and the senior Democrat on the House Veterans Affairs Committee. “We could be doing so much more.”  Last year, the United States Court of Appeals in San Francisco excoriated the V.A. for “unchecked incompetence” in dealing with veterans’ mental health.

Patrick Bellon, head of Veterans for Common Sense, which filed the suit in that case, says the V.A. has genuinely improved but is still struggling. “There are going to be one million new veterans in the next five years,” he said. “They’re already having trouble coping with the population they have now, so I don’t know what they’re going to do.”

Last month, the V.A.’s own inspector general reported on a 26-year-old veteran who was found wandering naked through traffic in California. The police tried to get care for him, but a V.A. hospital reportedly said it couldn’t accept him until morning. The young man didn’t go in, and after a series of other missed opportunities to get treatment, he stepped in front of a train and killed himself.

At some VA hospital inpatient treatment program had a six-month waiting list to get mental health services. According to one vet, “Getting an appointment is like pulling teeth,” he said. “You get an appointment in six weeks when you need it today.”

On top of these gruesome findings, some employers are wary of hiring veterans because of potential mental health issues. “There’s a whole host of questions you can’t legally ask, but I must say that somehow in interviews it comes out,” says Jim Pabis, a Colonel in the New York Army National Guard and Iraq combat vet who runs an executive search firm in Saratoga Springs, NY.
Nearly half of employers — 46 percent — said PTSD or other mental health issues were challenges in hiring employees with military experience, according to a 2010 Society of Human Resource Management survey. And a 2011 survey of 831 hiring managers by the Apollo Research Institute found that 39 percent were “less favorable” toward hiring military personnel when considering war-related psychological disorders.

According the the House Armed Services committee, there are only 35% of the needed mental health professional needed today in the VA and that number is not going to change for the foreseeable future.

What to do?

There are some potential solutions the VA rejects out of hand; Computer technology now being tested at the University of Nebraska; Internet delivery of mental health therapies like PTSDSTRESS.COM; Anonymous treatment. If it’s not cognitive behavior therapy which requires a therapist and numerous sessions, or exposure therapy, the VA’s not interested. And drugs, although proven ineffective are still being prescribed, particularly opiates.

Is this anyway to treat veterans who have gone to war for us?  And to all the politicians, are these American values for which they proclaim in their political campaigns and fund raising?

It’s a national, political, and governmental disgrace.

Jeff Eastman

jeffeastman@ptsdstress.com

PTSDSTRESS.COM