Study: Lack of Consistency, Flaws in PTSD Research Methodology Hamper Prediction-Making Ability
News of an interesting Australian study, from PR Inside:
While a number of risk factors such as injury severity, demographic factors and compensation-related factors have been identified, none is strong enough to reliably predict which patient will develop the disorder. PTSD is characterized by flashbacks of the event, anxiety, and social withdrawal. Victims of major trauma are at significant risk of developing PTSD, with about 15% developing the disorder within a year of the injury.
A study in the July issue of ANZ Journal of Surgery titled 'Predictors of Post-Traumatic Stress Disorder following Major Trauma' by Professor Ian Harris et al. argues that the lack of consistency of previous PTSD studies is a result of methodological flaws such as selection bias, and poorly defined diagnostic criteria.
The authors investigated the association between injury severity, demographic and compensation-related factors with the development of PTSD and found that the disorder was also independently associated with having an unsettled compensation claim, their use of lawyer services and the placement of blame on others for the injury.
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Continuing:
Another study in the same issue of ANZ Journal of Surgery claims that there is no existing risk factor model that enables an accurate prediction of how patients will be affected psychiatrically in the aftermath of the injury.
Author of 'Predictors of Post-traumatic Stress Disorder after Major Injury', Professor Alexander Cowell McFarlane says, 'The inconsistencies in PTSD predicators suggest the pivotal role of health-care professionals in the identification of patients at risk of developing psychiatric disorders.'
He adds, 'While risk factors should be considered, the traumatic events are sufficient to elicit symptoms in the individuals. Ultimately, it is the surgeons' skill in the management of the psychological recovery that will play a critical role in the patients' rehabilitation'.
__ These papers are published in the July 2008 issue of ANZ Journal of Surgery (Vol. 78, Issue 7, 2008).
About ANZ Journal of Surgery ANZ Journal of Surgery, established more than 70 years, is the leading surgical journal published in Australia, New Zealand and the South-East Asian region. The Journal is dedicated to the promotion of outstanding surgical practice and research of contemporary and international interest. ANZ Journal of Surgery publishes high-quality papers related to clinical practice and/or research in all fields of surgery and its related disciplines. A programme of continuing education for surgeons at all levels is also provided.
A federal judge presiding over an important veterans' healthcare rights case against the VA has accepted into evidence a controversial email suggesting fewer PTSD diagnoses be given to veterans coming in for care. This is the same case that first had the government attempt to dismiss it in its entirety, arguing that vets have no legal right to expect specific types of medical care. The case moved forward nonetheless, with testimony and closing arguments taking place in April.
A recently surfaced e-mail by a Department of Veterans Affairs psychologist was added Friday to the evidence a federal judge is considering in deciding whether to order a massive overhaul of the agency's health care system.
Two veterans groups sued the VA last year, alleging that its mental health care and benefits award system were so flawed that a federal judge was needed to step in. U.S. District Court Judge Samuel Conti was deciding what to do with the VA after a two-week trial without a jury ended in April.
On Friday, he took the unusual step of briefly reopening the case so he could formally consider the e-mail, in which the psychologist suggests that counselors minimize their diagnoses of severe mental disorders in soldiers. A transcript from a June 4 hearing on the missive before the Senate Veterans' Affairs Committee also was added to the trial evidence.
Read more on this in the Fog City Journal, or more on April's trial (which I was too swamped to cover here at the time) in extended.
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Suicides among veterans of wars overseas occur "just like cancer occurs," and are not an indication of negligence by Veterans Affairs Department mental health care providers, a top VA official has argued in a lawsuit filed by two veterans groups. The official said he does not know how well VA hospitals are complying with a directive to provide 24-hour referrals to veterans with mental health problems. ...
Internal VA memos released at the trial in April disclosed that in February, the department knew it was facing 1,000 suicide attempts per month, which the veterans groups argued could have been avoided if VA had adhered to its 2004 Veterans Health Administration Mental Health Strategic Plan, which called for development of a "national, systemic program for suicide prevention."
A deposition by a VA medical center psychiatrist caring for veterans of the wars in Iraq and Afghanistan backed up the veterans groups' assertion that the department had not done enough to provide adequate mental health care for all veterans.
Dr. Marcus Nemuth, medical director of Psychiatry Emergency Service for VA's Puget Sound Health Care System in Seattle, which operates three hospitals, said in his deposition on March 25 that he expected a high volume of post-traumatic stress disorder cases among veterans returning from Afghanistan and Iraq. He said he was concerned with both with the quantity and quality of care provided to those veterans.
Nemuth said during the past year he had seen such a growth in the caseload of Afghanistan and Iraq veterans seeking psychiatric emergency help at the Seattle VA hospital that he concluded the department faced a "tsunami of medical need."
But William Feeley, the Veterans Health Administration's deputy undersecretary for health for operations and management, said in an April 9 deposition that VA did not have a metric to track suicides or attempts. He added that he could not recall a time since he took office in February 2006 when VA had conducted a quarterly review of suicides or attempts among the department's 21 Veterans Integrated Services Networks. ...
In June 2007 Feeley sent out a memo to Veterans Integrated Services Network directors requiring hospitals and community-based outpatient clinics to provide an initial evaluation within 24 hours to veterans who requested or were referred for mental health evaluation and/or substance abuse treatment. Feeley also told network directors that as of Aug. 1, 2007, follow-up to these evaluations should occur within 14 days.
In his deposition Feeley said the June 2007 memo was sent in part in response to a May 2007 VA inspector general report that found initiatives detailed in the mental health plan pertaining to 24-hour crisis availability, outreach, referral and development of methods for tracking veterans at risk had not been deployed systemwide.
The inspector general recommended that VHA facilities make arrangements for 24-hour crisis and mental health care availability, either on site or through a hot line staffed by trained personnel. In addition, the IG said, an on-call mental health specialist should be available to crisis staff.
Feeley could not say during his deposition whether the policies laid out in his memo for 24-hour mental health referral and 14-day follow-up had been adopted throughout VHA. And aside from the suicide hot line, he could not say whether VHA had complied with other recommendations contained in the IG report. He said he "would have some trust in the organization" that the memo had been met with compliance. Otherwise, he said, "we will be spending millions of dollars related to auditing procedures."
Melvin Goldman, an attorney at Morrison & Foerster, the San Francisco law firm representing the veterans groups, asked Feeley: "If those millions of dollars resulted in the saving of one veteran's life, wouldn't they be worthwhile?" Feeley answered: "I think we have to make tough judgments in the industry on how to best measure success."
Feeley said he intended to ensure compliance with his memo through random site visits, saying he had completed five or six such visits as of April. But Antonette Zeiss, deputy chief consultant for patient care services at VA's Office of Mental Health Services, said at a pretrial hearing in March that site visits had been completed at only two VA facilities, in Los Angeles and Pittsburgh. Zeiss did not provide details on compliance in Pittsburgh, but said the Los Angeles facility was not in full compliance.
Gordon Erspamer, a Morrison & Foerster attorney, said in a trial brief that the 24-hour mental health evaluation procedures detailed in the Feeley memo as well as other suicide prevention steps taken by VA, such as the suicide hot line, amount to "nothing more than an empty promise on which too many veterans have tragically learned they cannot rely."
Justice Department attorney Daniel Bensing in his closing argument on April 30 called the charges by the veterans' groups "extreme and outrageous," adding that VA is providing "world-class health care in the mental health area."
A top-ranking official at the Department of Veterans Affairs defends the agency’s treatment of disabled veterans and denies the agency has tried to cover up the number of veterans committing suicide.
Dr. Michael Kussman, a department undersecretary for health, testified during a trial in San Francisco federal court that will determine whether the VA is shirking its duty to provide adequate mental health care and other medical services to millions of veterans. ...
In court, plaintiffs’ lawyer Arturo Gonzalez clashed Thursday with Kussman over how to compile and report the suicide rates. For instance, VA Secretary James Peake told Congress in a Feb. 5 letter that 144 combat veterans of Iraq and Afghanistan committed suicide between October 2001 and December 2005.
But Gonzalez produced internal VA e-mails that contended that 18 veterans a day were committing suicide. Kussman countered that the figure, provided by the Centers for Disease Control and Prevention, included all 26 million veterans in the country, including aging Vietnam veterans who are reporting an increased number of health problems.
Kussman said Thursday that suicide prevention was a VA priority and that the agency instituted new measures in the past 18 months, including training its workers to identify suicidal patients and establishing a 24-hour suicide hot line for veterans. Court documents given to the judge by Gonzalez showed that 2,508 veterans called the hot line in March, the busiest month so far.
“People are using it,” Kussman said. “It’s a good thing.”
Gonzalez also asked Kussman to explain several e-mail chains among agency officials that discussed an unwillingness to share suicide statistics with CBS News, which was preparing a story on the subject.
“I don’t want to give CBS any more numbers on veterans suicides or attempts than they already have — it will only lead to more questions,” wrote Everett A. Chasen, chief communications officer in a March 10 e-mail to several VA officials.
On Monday, the first day of trial, an e-mail message written in December by Dr. Ira Katz, the agency’s mental health director, was given as evidence. It alerted Kussman and others that 12,000 veterans under VA care were attempting suicide a year.
“Is this something we should (carefully) address ourselves in some sort of release before someone stumbles on it?” the e-mail asks. Katz also reported that of the average of 18 military veterans who kill themselves each day, four to five of them are under VA care when it happens.
The issue of whether veterans with mental health problems are neglected or whether their sheer numbers are overwhelming the system divided closing arguments on Wednesday in a class-action lawsuit in federal court here.
Arturo J. Gonzalez, the lawyer arguing on behalf of the Veterans for Common Sense and the Veterans United for Truth, the two groups who brought the lawsuit against the Department of Veterans Affairs, said that the agency had failed to fully put into effect an action plan it developed four years ago.
The fact that it takes more than 180 days to process a veteran’s claim for benefits represents a “pattern of neglect,” Mr. Gonzalez said, adding that anyone who enters an appeal has to wait four and a half years for a resolution.
“I don’t know how any veteran can stand it and stick with it and get to the end of this process,” Mr. Gonzalez said. He also emphasized the high rate of suicide attempts, 1,000 a month, among the 5.6 million veterans that the V.A. treats, as a sign that mental health issues need far greater attention.
Daniel Bensing, who made the closing arguments for the V.A., noted that 838,000 claims were filed last year, an increase of 25 percent, because of the jump in veterans from Iraq and Afghanistan and a surge from aging Vietnam veterans. While acknowledging the delays were lengthy, he said that the increase in claims for help was one of four factors causing problems.
The others he cited were that the claims are highly complex, not least because the ties linking veterans’ military records to their medical problems have to be investigated; that the claims process is an open one that allows veterans to add information at any time; and budgetary limitations.
While acknowledging suicide as a serious problem, Mr. Bensing also emphasized that change takes time given that the V.A. runs the largest health care system in the country. “It cannot all be done immediately like plaintiffs seem to think,” he said.
The plaintiffs were not seeking monetary damages but want the judge, Samuel Conti, to intervene to force the V.A. to run more efficiently.
Are PTSD-Medicated Veterans Dying in Sleep -- or Committing Suicide?
Important story on the cluster of OEF/OIF veterans who have recently been found to have died in their sleep, or thought to have committed suicide, while heavily medicated and being treated for PTSD. First, a May 23 introduction by Julie Robinson of the Charleston Gazette:
A Putnam County veteran who was taking medication prescribed for post-traumatic stress disorder died in his sleep earlier this month, in circumstances similar to the deaths of three other area veterans earlier this year.
Derek Johnson, 22, of Hurricane, served in the infantry in the Middle East in 2005, where he was wounded in combat and diagnosed with post-traumatic stress disorder while hospitalized.
Military doctors prescribed Paxil, Klonopin and Seroquel for Johnson, the same combination taken by veterans Andrew White, 23, of Cross Lanes; Eric Layne, 29, of Kanawha City; and Nicholas Endicott of Logan County. All were in apparently good physical health when they died in their sleep.
Johnson was taking Klonopin and Seroquel, as prescribed, at the time of his death, said his grandmother, Georgeann Underwood of Hurricane. Both drugs are frequently used in combination to treat post-traumatic stress disorder. Klonopin causes excessive drowsiness in some patients.
He also was taking a painkiller for a back injury he sustained in a car accident about a week before his death, but was no longer taking Paxil.
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Continuing:
Stan White, father of soldier Andrew White, has become an advocate for families of returning veterans with post-traumatic stress disorder. During his son's struggle with the disorder and since his death, White has tracked similar cases. He knows of about eight in the tri-state area of Kentucky, Ohio and West Virginia.
He and his wife, Shirley, introduced themselves to the Johnsons and Underwoods at Derek's funeral and offered their help. He is in contact with the office of Sen. Jay Rockefeller, D-W.Va., who is a member of the Veterans' Affairs Committee. Rockefeller requested an investigation into these deaths, which is ongoing, said Steven Broderick, the senator's press secretary.
"When I talked to his family about Derek, I realized it was the same old story," said White. "It was all too familiar. He was taking those same drugs as the others, and, yes, I believe they are still prescribing that combination."
After speaking with family members, White wonders if the patients are taking the medicine as prescribed. He said PTSD patients suffer short-term memory loss and shouldn't be relied upon to track their medications.
Georgeann Underwood agrees.
"You shouldn't put vulnerable, mentally unstable people on drugs like that," she said.
An outgoing, personable young man who worked at several jobs to support his young family, Johnson frequently was offered other jobs by customers in the stores where he worked, Underwood said. In 2006, he returned from the Middle East depressed and short-tempered. Johnson had operated an M249 Squad Automatic Weapon, or rapid-fire machine gun, and rarely spoke about his experiences there.
After his military prescriptions ran out, Johnson's medications were prescribed by private physicians because he refused to go the VA hospitals where he said he was required to wait long periods of time for appointments. His grandparents paid for his medications.
"He had a very short fuse," Ray Johnson said. "That was the biggest difference in his personality after he came back."
Until his death, he worked 12 or 16 hours a day. He was an electrical apprentice at the John Amos Power Plant until he was let go when his work hours approached the union limit for apprentices. He was on his way to apply for another job when the car he drove was rear-ended on April 24.
On May 20, Marine Cpl. Oligschlaeger, 21, was found dead in his barracks room at Twentynine Palms Marine Corps Air Ground Combat Center in California. Oligschlaeger was a mortar man assigned to the 1st Marine Division, and had recently returned from his second tour of duty in Iraq.
While the death was initially viewed as a suicide, Oligschlaeger's family and friends are not ready to concede that he willingly ended his life. The family will wait for the autopsy report from the Marine Corps, Smith said.
"He suffered from post traumatic stress disorder, and he was struggling with it. He was on eight different medications. From what we have learned, there was not much medical supervision on how he was to take the medications," Smith said.
"His Marine friends have said that, knowing Chad and having fought by his side, they don't believe he was capable of committing suicide. Our family feels the same way." Smith, whose daughter, Julie, was raised in Carlsbad and graduated from Carlsbad High School, said her grandson graduated from McNeil High School in Austin, Texas, and immediately joined the Marines. ...
Oligschlaeger officially became a Marine on July 18, 2004. He graduated from boot camp in October of that year and then headed to the School of Infantry at Camp Pendleton, Calif. On completion of the school, he was designated as a mortar man and was assigned to the 3rd Battalion, 7th Marines, 1st MARDIV based at Twentynine Palms. In 2005, within just a few short months of his enlistment, he found himself deployed to Ar Ramadi in Iraq.
"When he came home, he said he did not want to go back," Smith said, recalling a conversation with him. "Last year, he learned that he was being sent back. He expressed again that he didn't want to go back. He was told that he would follow orders or the alternative would be a dishonorable discharge. So he went back to Iraq." She said when he returned, he struggled to come to terms with what he had seen and done in Iraq and sought help from the military.
"At the age of 18, he had seen more horrors than I have ever seen in my life," Smith said. "I don't know if I could hold someone in my arms that was badly wounded and watch him die, or see dead bodies all around. He really struggled with that after his first tour in Iraq."
She said Oligschlaeger's second tour added to his stress.
But with his enlistment up just before he died, "he was getting ready to get out, marry his fiancée and go to school to become a firefighter and a paramedic." Since her grandson's death, Smith said she has learned more about PTSD and how little help there is available to service men and women, and their families who are dealing with it.
"I always thought that anyone in the military who has fought in a war is well taken care of if wounded physically or suffering with PTSD," she said. "But that's not the case, I have learned. "They give PTSD patients a bunch of pills. Where's the counseling they need? Where's the compassion for those who come home hurt after fighting for our freedoms? It's not right." ...
"It upsets me to find out that in Chad's case, and probably in many more cases, the military gives these kids suffering from PTSD all this medication and does not monitor them. It's disgraceful," she said.
[T]he Army found a new “trend” as it grouped all of its wounded soldiers into one system where they could be carefully monitored: 11 deaths in that population due to suicide, accidental overdose by prescription medications, and in motor vehicle accidents. Schoomaker said the combination of multiple prescription drugs — usually pain medication — mental health issues, alcohol and no supervision on the weekends are contributing to the problem.
Lt. Gen. Eric B. Schoomaker, the Army’s surgeon general, said there has been “a series, a sequence of deaths” in the new, so-called “warrior transition units.” Those are special units set up last year to give sick, injured and war-wounded troops coordinated medical care, financial advice, legal help and other services as they transition toward either a return to uniform or back into civilian life.
Without giving a number, Schoomaker said the deaths among the convalescing troops were “accidental deaths, we believe, often as a consequence of the use of multiple prescription and nonprescription medicines and alcohol.”
“This isn’t restricted to the military, alone, as we all saw the unfortunate death of one of our leading actors recently,” Schoomaker told Pentagon reporters. ... Schoomaker said he didn’t know whether the number of overdoses among soldiers was on the rise, but would try to provide statistics as soon as possible. The series of deaths was noticed and is getting attention partly because the new units concentrate the Army’s temporarily disabled and ill into special groups, thus making it possible for leaders to track and tabulate their health issues more closely and carefully than ever before.
There have been at least three accidental drug overdoses and four suicides among soldiers in special units the Army set up last summer to help war-wounded troops, officials said late Thursday.
A team of pharmacists and other military officials met early this week at the Pentagon to look into the deaths in so-called "warrior transition units" - established to give sick, injured and wounded troops coordinated medical care, financial advice, legal help and other services as they attempt to make the transition toward either a return to uniform or back into civilian life.
The Army said officials had determined that among those troops there have been 11 deaths that were not due to natural causes between June and Feb. 5. That included four suicides, three accidental overdoses of prescribed medications, three deaths still under investigation and one motor vehicle accident, the Army said.
Time's Mark Thompson introduces us to Iraq vet Sergeant Christopher LeJeune in "America's Medicated Army:"
LeJeune visited a military doctor in Iraq, who, after a quick session, diagnosed depression. The doctor sent him back to war armed with the antidepressant Zoloft and the antianxiety drug clonazepam. "It's not easy for soldiers to admit the problems that they're having over there for a variety of reasons," LeJeune says. "If they do admit it, then the only solution given is pills."
While the headline-grabbing weapons in this war have been high-tech wonders, like unmanned drones that drop Hellfire missiles on the enemy below, troops like LeJeune are going into battle with a different kind of weapon, one so stealthy that few Americans even know of its deployment. For the first time in history, a sizable and growing number of U.S. combat troops are taking daily doses of antidepressants to calm nerves strained by repeated and lengthy tours in Iraq and Afghanistan. The medicines are intended not only to help troops keep their cool but also to enable the already strapped Army to preserve its most precious resource: soldiers on the front lines. Data contained in the Army's fifth Mental Health Advisory Team report indicate that, according to an anonymous survey of U.S. troops taken last fall, about 12% of combat troops in Iraq and 17% of those in Afghanistan are taking prescription antidepressants or sleeping pills to help them cope. ...
[I]f the Army numbers reflect those of other services — the Army has by far the most troops deployed to the war zones — about 20,000 troops in Afghanistan and Iraq were on such medications last fall. The Army estimates that authorized drug use splits roughly fifty-fifty between troops taking antidepressants — largely the class of drugs that includes Prozac and Zoloft — and those taking prescription sleeping pills like Ambien.
In some ways, the prescriptions may seem unremarkable. Generals, history shows, have plied their troops with medicinal palliatives at least since George Washington ordered rum rations at Valley Forge. During World War II, the Nazis fueled their blitzkrieg into France and Poland with the help of an amphetamine known as Pervitin. The U.S. Army also used amphetamines during the Vietnam War. ...
The increase in the use of medication among U.S. troops suggests the heavy mental and psychological price being paid by soldiers fighting in Iraq and Afghanistan. Pentagon surveys show that while all soldiers deployed to a war zone will feel stressed, 70% will manage to bounce back to normalcy. But about 20% will suffer from what the military calls "temporary stress injuries," and 10% will be afflicted with "stress illnesses." Such ailments, according to briefings commanders
Information on the medication-suicide issue:
Last year the U.S. Food and Drug Administration (FDA) urged the makers of antidepressants to expand a 2004 "black box" warning that the drugs may increase the risk of suicide in children and adolescents. The agency asked for — and got — an expanded warning that included young adults ages 18 to 24, the age group at the heart of the Army. The question now is whether there is a link between the increased use of the drugs in the Iraqi and Afghan theaters and the rising suicide rate in those places. There have been 164 Army suicides in Afghanistan and Iraq from the wars' start through 2007, and the annual rate there is now double the service's 2001 rate.
At least 115 soldiers killed themselves last year, including 36 in Iraq and Afghanistan, the Army said on May 29. That's the highest toll since it started keeping such records in 1980. Nearly 40% of Army suicide victims in 2006 and 2007 took psychotropic drugs — overwhelmingly, selective serotonin reuptake inhibitors (SSRIs) like Prozac and Zoloft. While the Army cites failed relationships as the primary cause, some outside experts sense a link between suicides and prescription-drug use — though there is also no way of knowing how many suicide attempts the antidepressants may have prevented by improving a soldier's spirits. "The high percentage of U.S. soldiers attempting suicide after taking SSRIs should raise serious concerns," says Dr. Joseph Glenmullen, who teaches psychiatry at Harvard Medical School. "And there's no question they're using them to prop people up in difficult circumstances."
Medication Selective serotonin reuptake inhibitors (SSRIs) are a type of antidepressant medicine. These can help you feel less sad and worried. They appear to be helpful, and for some people they are very effective. SSRIs include citalopram (Celexa), fluoxetine (such as Prozac), paroxetine (Paxil), and sertraline (Zoloft).
Chemicals in your brain affect the way you feel. When you have or depression you may not have enough of a chemical called serotonin. SSRIs raise the level of serotonin in your brain. There are other medications that have been used with some success. Talk to your doctor about which medications are right for you.
Even though I'm sharing quite a big chunk in the interest of education, head over to the Sidran Institute to read an article on PTSD medications for combat veterans written by military psychiatry expert Jonathan Shay, Md, Phd:
Everything I say here is my point of view, and carries no claim of special authority. Also, what I say here is no way complete. I have left out many important subjects, such as drug interactions, what medical conditions forbid the use of a given drug, overdoses and toxicity, and most specific side-effects. Also, many psychiatrists who also care about combat veterans will disagree with what I say here, particularly about the benzodiazepines like Ativan. Combat PTSD is moral, social, philosophical, and spiritual injury. The biological nature of human beings is to be moral, social, philosophical, and spiritual, so the injury also shows itself as medical disorders.
Healing is psychological, social, spiritual—no medicine can cure combat PTSD. However, healing can never mean a return to 17-year old innocence. Healing means building a good human life with others—a life that a veteran can embrace as his own.
Combat trauma brings about long-lasting changes in brain chemistry. We do not know whether these are permanent or can be reversed by psychological/social healing. A few existing medications can help some men with some symptoms of PTSD. We also do not know whether this changes the long-term outcome for the better, but the human payoff in reduced suffering is unmistakable.
Therapeutic effects (benefits) and side-effects
Drugs are dumb chemicals—they don’t know what they are. They aren’t born in a laboratory with a word spelled out across their foreheads “Anti-depressant!” or something like that. Most have been discovered by accident. Almost every drug known has multiple effects on the body. Which effect is a therapeutic (beneficial or main) effect and which is an unwanted side-effect is a human decision, not a chemical decision.
Illustrations: Think of the well-known drug Elavil (generic name: amitriptylene). What is it? An anti-depressant you say? Why is it used in the Intensive Care Unit to stabilize the heart beat of certain patients? Not because depression causes their irregular heart beat. Why is it used by neurologists to treat migraine? Not because depression causes migraine—and the doses that work for migraine are usually too small to touch a depression. The point is, of course that a drug doesn’t know what it is. Its successful human uses make it an anti-depressant, a migraine drug, an anti-arrhythmic.
What about side-effects? Again, this is a matter of the human purposes involved. Think of the anti-depressant trazodone (most common trade name: Desyrel). Its most prominent side-effect is drowsiness. I prescribe trazodone fairly often as a sleep medication to veterans who are on fluoxetine. It has the advantage that it doesn’t lose its effect with repeated use (which also means there’s little withdrawal syndrome when the veteran stops it), and it’s almost useless as a pill to kill yourself with. So here the side-effect is the main effect and the anti-depressant effect is a side-effect—Is anybody confused yet?
Important to remember: When a drug has several different effects, each effect has its own way of unfolding in time. How long a drug takes to produce its different effects, is often different for each effect. The side-effects may hit immediately and the main effect only develop after several weeks! With another drug it’s the opposite, with the main effect coming on immediately and the side effects happening later. An analogy: Think of a plant on your window sill. You’ve been away for the weekend and it’s gotten dry and droopy. You give it water and the leaves begin to respond almost as soon as the water goes on—the plant responds as soon as the water reaches the roots. If the roots dry out, again the plant wilts again. This is like a pharmacokinetic effect. If you put some fertilizer in the water, on the other hand, this reaches the roots as fast as the water reaches them, but you may not see any result for days or weeks. This is because the plant has to build new parts in its own cells. This is like a pharmaco-dynamic effect.
Example: Most anti-depressants reach the brain quickly, but take several weeks to have an anti-depressant effect. This is probably because the changes that have to take place in the cells take that long to happen. However, some side-effects like a dry mouth or drowsiness happen quickly because they do not require cells to make anything new, but only to do what they’re already doing faster or slower. ...
Characteristics of good drugs for combat PTSD
Makes something better for the veteran Does not lead to tolerance Does not lead to abuse Cannot be used to commit suicide Does not require blood tests Does not cut a person off from the world or from himself Causes few, bearable side-effects
Some good drugs for combat PTSD
--Serotonin reuptake inhibitors: fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), etc.
The main effect of fluoxetine on combat vets with PTSD whom I’ve worked with is to allow them more time to think before they act, particularly in anger. It does this without sedation or cutting a man off from himself or the world. The duration of anger, once aroused, is also shorter. Greater self-mastery of anger leads to an increase in self-respect and relief from a sense of humiliation. Most men feel humiliated after they go off on people in situations they really would not have, if they had had the freedom to choose. In addition to this, fluoxetine may have a direct anti-depressant effect in combat PTSD. Fluoxetine effects on self-control and rage may take many weeks to kick in, although I’ve seen it as soon as a week.
Fluoxetine is practically useless as a drug to overdose on, if the goal is suicide. All anti-depressants have been known to give long-time depressed people the energy to kill themselves, and fluoxetine is no different. Many combat veterans go through brief periods of intense despair during the first few months that they are feeling generally better, more alive, and are coming out of their bunkers. Support from other veterans, family, therapists is especially important during those times—nobody should try to go through it alone, or have to. Someone trying to go through it alone might try to kill himself during one of these times of despair. Remember that this is no special risk with fluoxetine, but is a risk when anyone recovers from severe depression. Several vets I’ve treated have had bouts of despair like this, but none has ever tried to kill himself during one, because support and therapy are built into the program I’m a part of. The much-publicized claim that Prozac has special powers make a previously non-suicidal person violently suicidal is without good foundation. Fluoxetine does have side effects, which not everyone can stand, and it doesn’t work for everyone. A full discussion of side-effects, some of which depend on the dose and others not, would be too long for this summary.
Fluoxetine is the first drug of its type to be released for use. Other drugs in the same family have now come along, sertraline (Zoloft) and paroxetine (Paxil). They have been tried by many combat vets around the country, and from what I hear they are not a lot different than fluoxetine as far as main and side-effects. In the relatively limited number of men I have treated with paroxetine and sertraline, this has been what I have heard from them. Paroxetine has a 24 hour half-life and no active metabolites [what the body turns the parent drug into], so if the actions of the drug are otherwise identical to fluoxetine, it will be a superior drug from a safety point of view, because it doesn’t hang around in the body so long. But on the down side, paroxetine may be expected to (and is reported to) have a withdrawal syndrome because it leaves the body so fast.
--Buspirone (Buspar)
This anti-anxiety drug works differently from the benzodiazepines (like Valium). Like anti-depressants it takes a few weeks to kick in. It takes effect gradually, like the tide coming in. It usually has few side-effects and may help some people with intrusive thoughts and nightmares. Buspirone has no street value and is almost useless as a suicide pill. I am not aware of other drugs in this family coming along, but I hope there will be. I have recently read the report of a colleague who works with combat veterans that the best results with buspirone come at doses above 60mg/day. I do not yet have enough personal experience with patients who have tried this, to confirm or deny this report.
--Beta-blockers: propranolol (Inderal), nadolol (Corgard), atenolol (Tenormin), etc.
This family of drugs breaks the mind-body-mind vicious cycle in rage reactions, by blocking the body effects of adrenalin. For example, if someone at work says something offensive about Vietnam vets, the words start the mind working into rage. The rage starts in the mind—but within a second the body responds with adrenalin, which makes the gut burn, the heart pound, the muscles tense. These body changes send loud messages back up to the mind. For some veterans, the roar of the body drowns out all thought and shuts out everything else coming in. When adrenalin is roaring, it’s impossible for most people to think clearly and to take in non-combat possibilities in the situation. This is the mind-body-mind vicious cycle that beta-blockers break up. By blocking the adrenalin effect on the body they prevent the roar of the body from drowning out all thought and choice about what you really want. “Is it really in my interests to rip this guy’s lungs out? Is it really what I want to do?” When adrenalin is roaring these questions sometimes cannot be heard.
Some vets feel that these medications weaken them, because they associate being pumped up with adrenalin with their personal strength. When someone is over-medicated on these drugs (which started life as blood pressure meds) he is weaker because his blood pressure is too unstable, but this is usually not a problem with a correct dose. Tolerance does not develop to the anti-adrenalin effects of these drugs. Massive overdoses of a beta-blocker can be fatal, by dropping the blood pressure and slowing the heart to the point that the brain is not getting enough blood flow.
--Low-dose lithium
Some respected practitioners of PTSD pharmacotherapy speak highly of lithium to help veterans maintain their self-control when they are angry. This means doses of about 600mg/day, far less than is usually needed to treat bipolar affective disorder (manic-depressive disorder), and does not imply that the doctor recommending this thinks that the veteran is manic-depressive.
I agree that this can help some veterans, but I have found fluoxetine to be more reliable. It is also safer, in that lithium is readily fatal in a large overdose. For a veteran who cannot tolerate fluoxetine and whose life has been blighted by explosive violence, low-dose lithium may be a good thing to try. [no blood tests because of low dose]
Other drugs for special circumstances
--Trazodone (Desyrel) for sleep
Trazodone is a non-toxic anti-depressant that has a useful side-effect: It causes drowsiness, and people don’t get tolerant to this effect. Because fluoxetine slows the rate that the liver breaks down trazodone, much lower doses are needed for sleep by patients on fluoxetine than people who are not on fluoxetine.
--Quinine for nocturnal myoclonus
This is the “sleep jerks.” If quinine works, the veteran himself may not notice much but his wife has much better sleep.
--Low-dose antipsychotics for violent urges: thioridazine (Mellaril), mesoridazine (Serentil), etc.
The key here is brief treatment on an as-needed basis, controlled by the veteran himself [for a limited time, when hospitalization is not possible]. The doses needed have been low, and I prefer the sedating anti-psychotics like thioridizine and mesoridizine, which appear to carry the least risk of dangerous (neuroleptic malignant syndrome) or possibly irreversible (tardive dyskinesia) complications. An unexpected additional use for these drugs also involves brief, low-dose treatment: to help someone who wants to get off marijuana get through the withdrawal syndrome.
Future drugs
Many combat veterans with PTSD feel dead inside. It is possible that this psychic numbing comes from the brain making its own opium-like substances, and that opiate blockers can give people back their feelings. It is not yet clear whether this works. I hope the future will bring a drug like clonidine (trade name: Catapres) that people do not develop a tolerance to. In my experience, about one out of five combat veterans with PTSD experience major improvement of almost all of their PTSD symptoms on clonidine—but the heartbreak has been that they grew tolerant to it in about a week. Any future drug in this family that does not induce tolerance to this effect will relieve much suffering. A new drug in this family, guanfacine (tradename, Tenex) has recently appeared, but I have no experience with it and have not heard any reports of usefulness to combat veterans with PTSD.
The most helpful drugs are likely to be ones that don’t yet exist.
Read Shay's full list of drugs to avoid and check the "medication" tag for related content or choose from those listed below.
Tennessee Caregivers 'Healing the Hidden Wounds' at Nashville Summit
On May 21, Nashville Public Television, National Alliance on Mental Illness-Tennessee, and YMCA/Restore Ministries hosted a day long summit amidst the backdrop of magnificent Foundren Hall. The weather and the charm of the Scarritt Bennett Center grounds couldn't have been any more inviting. And those gathered couldn't have been any more gracious or interesting or sharp.
"Healing the Hidden Wounds," a symposium on veterans and combat related depression united the area's stakeholders for a day of networking, brainstorming, and drafting plans for actions taken after the event. Efforts like these are welcomed and go a long way in supporting the mental health and successful reintegration of returning veterans and their families.
Both television special and conference help to raise awareness; individuals and groups also form new networks and relationships, sharing resources and knowledge. Attending were caregivers of all types and stripe, former veterans galore, law enforcement and military support types.
The intimate, face-to-face setting and well-thought out program offered everyone the chance to get lot of work done in a short period of time. A very successful summit by all counts I'd like to share with you.
Click on 'Article Link' below tags for more...
Quick sidebar: My camera has been in Nikon's hands for repairs now for nearly two months. Once again here, relying on the kindness of strangers -- now, newfound friends -- for providing some great event photos to share with you.
Photos: (c) Kathy Edson and Kenny Allred.
My keynote address:
Thank you to Nashville Public Television – most especially Kathy Edson who was kind enough to extend an invitation to me to share this day with you today – NAMI Tennessee and YMCA/Restore Ministries for organizing this incredible summit of great hearts and minds. It’s an honor to be asked to say a few words today, but most especially I’m excited about the chance to learn from you as well.
Thank you so much for your service.
As we’ve just last Saturday celebrated Armed Forces Day, and this coming weekend we prepare to observe Memorial Day, I’d like to commend you for your vital service to our military families and to the nation as a whole.
My biggest inspiration in life has been my father. As a young boy growing up in Hungary, he witnessed WWII and the Nazi occupation from his family farm in the Hungarian countryside. As a teenager, after the conclusion of the war, he then had to live under repressive Soviet rule.
He was conscripted into the Hungarian Army when he was 20, and served in antitank artillery for two years beginning in 1953. But it would be 1956 that would change his life’s direction – and mine – when he picked up arms and joined others in a quest for freedom on the streets of Budapest. The Hungarian Revolution had begun.
Without hesitation, my father joined his fellow countrymen and women in liberty’s cause. My father and mother later fled to the West, after the Soviet Union put down the revolt, with a wave of others landing on the shores of America.
He again became a soldier in 1958.
This time, he wore a United States Army uniform. Imagine. Within a brilliant burst of 5 years, my father went from living a life of modest opportunity and great oppression to serving in the greatest military on earth as a combat engineer, stationed in Germany – with Elvis Presley no less.
[Laughter]
At 28, his two years of service behind him, he came home.
To America.
He was proud to wear the American uniform, he was proud to have been able to serve this country, his country. And even as a young girl I remember sneaking into the special closet in our home that contained his pressed and preserved uniforms and looking at them with wonder. I even slipped into them once (don’t tell my dad), and I remember the power that the uniform possessed.
As a current, obviously nontraditional older student attending Northern Illinois University, last Veterans Day I had the pleasure of hearing the school’s ROTC Department of Military Sciences Chairman LTC Craig Engel speak about the special aura of the United States military uniform. He said this that day:
“The act of donning a military uniform is a deeply symbolic act. It always has been, and it likely always will be. It is an act that experiences a deep and selfless commitment to the idea we call America. When ordinary men and women step into the uniform of this nation, they commit themselves to the performance of an extraordinary duty, which may entail the highest and most fearsome call.”
We as citizens must never forget this: That while we may not wear the uniform, those who do are serving not only the country we call America – but they are also forwarding all of her possibilities in doing so as well.
Those who answer the call as so many of you here have, selflessly sacrificing time with family and friends, putting the safety of your body and the peace of your mind on the line for all of us, deserve more than simply words of thanks. Civilians who reap the rewards of those personal sacrifices must honor those gifts and pay down that debt – if it is ever even possible -- with our attention, our respect, but mostly our actions on your behalf.
That’s what our father taught my sisters and me.
Ralph Waldo Emerson was right when he said, “Every man is a hero and an oracle to somebody.” On my present endeavor, Seattle Weekly reporter Rick Anderson was mine when he penned a piece called “Home Front Casualties.” It was the first such article I’d ever run across, listing a cluster of some 6 or 7 incidents that had occurred at Ft. Lewis.
This is what he wrote in 2005:
“Altogether since 2003, there have been seven homicides and three suicides on Western Washington soil involving active troops or veterans of Iraq … Five wives, a girlfriend, and one child have been slain; four other children have lost one or both parents to death or imprisonment. Three service members have committed suicide – two of them after killing their wife or girlfriend … No one can say if the killing can be directly connected to the psychological effects of war. But most involve a risk factor distinctive to the military – armed men trained to kill – and some killers carry the invisible scars of war.”
I began wondering...
• Why was there seemed to be so little news of this in the public sphere? • Were the incidents rare -- or were there others? • If so, what was our military and government doing to ease the problem? • Finally, what could I do to help?
Within months of beginning my search for answers, the ePluribus Media PTSD Timeline, a first-of-its kind online database designed as a starting point for further research, reporting and discussion of PTSD, was created alongside my online journal – PTSD Combat: Winning the War Within – which all eventually led to a small New York City publisher asking if I would write a book on combat PTSD.
With my vast amount of experience in the field, who was I to say no?
[Laughter]
There are some good things about being a new-comer to a subject. I started at the beginning, reading all of the military definitions and best books and studies on the matter I could find and reaching out to the real medical experts and veterans and advocates for advice and direction. I received some of the very best help and the greatest of embraces by those already working in this area – a true reflection of the high caliber and class and heart of the people working in this field.
About halfway through my education, it dawned on me that – depending upon the book or study in my hand presently – there were a lot of different terms for what we simply today refer to as PTSD.
I began jotting them down on a list.
Most of us are familiar with the more notable of these terms:
• The Civil War era brought us nostalgia, irritable or soldier’s heart • WWI christened their PTSD as shell shock, obviously reflecting the era’s powerful new quick-firing artillery piece and machine guns. • WWII’s broad and prolonged conflicts renamed it again to battle or combat fatigue • The Vietnam era called the reintegration problems veterans had, not very poetically, post-Vietnam syndrome
But there are dozens and dozens more labels pointing to essentially the same combat stress umbrella used and abused over the years. While being merely an aside to my main focus, in six months I’d amassed some 80 such terms.
I’ve listed them in the notes section in the back of Moving a Nation to Care, on page 161: railway spine, disorderly action of the heart, traumatic neurasthenia, gross stress reaction, Old Sergeant Syndrome, in-country effect, simple continued fever, lack of morale fibre...
What does all of this mean?
One generation after another “rediscovers” and “relabels” the post-war malady, depending upon their own particular needs at the time and if they can nail down an acceptable definition that can justify its existence.
Comedian George Carlin, someone who I had the pleasure of serving on three separate occasions during my 15-year career as a flight attendant (see, I served in uniform, too) [laughter], is known for his combative delivery and razor-sharp examination of the English language. Probably no one comes closer to showing our dysfunctional relationship with PTSD than Carlin, so I hope he doesn't mind if I share it with you in full:
I don't like words that hide the truth. I don't like words that conceal reality. …Americans have trouble facing the truth, so they invent the kind of a soft language to protect themselves from it, and it gets worse with every generation. …
There's a condition in combat. Most people know about it. It's when a fighting person's nervous system has been stressed to its absolute peak and maximum. …In the first world war, that condition was called shell shock. Simple, honest, direct language. Two syllables, shell shock. Almost sounds like the guns themselves.
That was seventy years ago. Then a whole generation went by and the second world war came along and very same combat condition was called battle fatigue. Four syllables now. Takes a little longer to say. Doesn't seem to hurt as much. Fatigue is a nicer word than shock. Shell shock! Battle fatigue.
Then we had the war in Korea, 1950. Madison avenue was riding high by that time, and the very same combat condition was called operational exhaustion. Hey, we're up to eight syllables now! And the humanity has been squeezed completely out of the phrase. It's totally sterile now. Operational exhaustion. Sounds like something that might happen to your car.
Then of course, came the war in Viet Nam, which has only been over for about sixteen or seventeen years, and thanks to the lies and deceits surrounding that war, I guess it's no surprise that the very same condition was called post-traumatic stress disorder. Still eight syllables, but we've added a hyphen! And the pain is completely buried under jargon. Post-traumatic stress disorder. I'll bet you if we'd of still been calling it shell shock, some of those Viet Nam veterans might have gotten the attention they needed at the time. I'll betcha. I'll betcha.
All of this indecision and back and forth has made it difficult for us to expand our knowledge base of the condition over the years. We seem to be forever in this dance of “does it really exist or not?” and if it does, what do we call it? Certainly this is something entirely new and unexpected.
We fell right in line with our behavior during the Afghanistan and Iraq war years. Today veterans and counselors can be heard saying that the term PTSD falls short in this way or that – that “psychological injury” or “deployment-related stressors” better describe what they’re experiencing. ‘Disorder’ – unlike injury - is too stigmatizing, too condemning of anyone to want to accept and so it should be dropped from the lexicon.
All of this may be valuable to consider and essential to doing, but we're back to dancing again while history keeps repeating itself.
Studies have shown that a certain and sure percentage of war veterans will have some psychological and physical fallout from their experiences in the years following their return home. Some may become strengthened by their experience, some may have to work a bit harder to get to that point.
But, veterans from all wars have found this to be so. For example, in February 2006, the Archives of General Psychiatry contained the findings of a University of California-Irvine study that reviewed the pension and health records of Civil War-era veterans.
• 15,000 Union soldiers • 44% reported post-war mental/”nervous” problems • Companies suffering highest casualties were at a higher risk for: o Cardiac o Gastrointestinal o Nervous diseases
Not much has changed for our generation of veterans. We have, however, lost some of our protective cultural rituals that used to be provided by society to warriors returning home from battle. Our troops are returning from deployments, but the wars go on. There doesn't make it easy to making peace and finding closure to all they've been through. So, we have to find other ways to support their journey home to our civilian world.
When they first return home, we have a unique window of opportunity to reach out and help troops with their processing of war. This was our great lesson post-Vietnam. If society checks out and absolves itself of its responsibilities and attention, no one wins. Not the veterans, surely – and not the larger fabric of society, either.
We know from PTSD research, that the first months and first year are especially important in laying down positive coping mechanisms and skills. Previous cultures seemed to have understood this more. They had cleansing rituals in place for their returning warriors that went far in washing their guilt and trauma and possible disillusion away.
Native American tribes, for example, put their returning warriors in the middle of community – they did not relegate them to their own hospitals and centers, far away from society. They also had community and individual rituals [returning warrior sent into the forest to place a gash on young tree].
But it's not just what we can do for them...it's also what they can do for us.
For the past few years, I’ve been fortunate to be able to write a lot about issues that concern our troops returning from Afghanistan and Iraq and their families. I’ve found that those who aren’t tied to the military in a direct way often wonder what significance veterans’ experiences have to their own peaceful lives at home. We at home often don’t realize the full value of our returning veterans.
While some of us know we should be there for them as they return to us after deployment, many of us don’t realize that they are equipped to help us, too. Their knowledge and presence are more important to us as a civilian population than we realize. No matter where one is these days, one thing is certain: We are living in violent times.
We are surrounded by a warrior culture – even in such places as a Midwestern rural college campus nestled amongst cornfields that should offer a peaceful and safe respite amidst the din of the scarier world outside. But, when a lone gunman violated our quiet campus that February day, killing 5 students before turning the gun on himself, he proved that we are indeed vulnerable everywhere.
Veterans, of course, understand this. They can understand the pain and loss we at NIU felt that day. I returned home that afternoon to a concerned call from a friend who is a local Vietnam veteran. Asking how I was doing, he said, “Well, you’re one of us now. You’ve just survived your first IED [improvised explosive device] attack.” Our experience on campus that day – as brutal and violent as it was – of course, can’t possibly be measured in the same terms as those experienced by our troops patrolling enemy streets in the Middle East. But I understood what he was trying to say.
But there were other remarkable connections that revealed themselves to me in the days that followed the shooting. For example, one of the students killed that day was 32-year old Julianna Gehant. She was said to have loved children and was studying to be a teacher. She was also a 12-year Army veteran who'd served in Bosnia and Korea before returning to school to get her teaching degree.
At Julianna’s funeral service, Rev. James E. Kruse spoke of the decorated soldier’s life and the circumstances of her death. He speculated about Julianna: Was she the woman students heard calling for others to run from a shooter as he reloaded and prepared to strike again?
“I don’t know for certain, but she’s a hero in my mind,” Kruse said at the Holy Cross Church service.
I's also heard in the days after the shooting that at least one former veteran on campus rushed in to come to the aid of students who were wounded, dragging some of them out and giving them medical attention.
When I learned the name of the medic, an Iraq War veteran and former Navy corpsman and veteran of Kosovo, Afghanistan and Iraq, now NIU student who I'd been playing phone tag with since the previous fall?
It was Jeff that had gone back to class and warned others to lock down. He ran towards Cole Hall. He – who’d told his wife not long before the incident that it was nice to be somewhere people weren’t shooting at him – came to the aid on campus.
I met with Jeff a couple of weeks later and gave him a big hug. He was humble and showed little signs that his heroism was anything special. He and Julianna embody what it means to be the very best of citizens. They showed us that day how valuable our veterans are to our communities far and wide in such dark times.
Their efforts on campus that cold February day are far from anomalies, although they don’t seem to get as much attention in our media. I’d like to close with another recent example of the value our veterans have for us right here at home.
Just last month, another recently-returned veteran – this one a Marine who was coping with PTSD and had been warned by doctors to avoid stressful situations, like motor vehicle accidents, because of their ability to trigger flashbacks, etc.
As fate would have it, Jeremy Lepsch, found himself in the vicinity of just such a scene on April 7, when he came upon an injured motorcyclist lying on the side of the road bleeding to death. As reported in the New York press, Jeremy stopped his car and got out, dodged traffic to get to the injured man and placed a lifesaving tourniquet on his mangled left leg. He also reassured the man that he was a veteran and would help him, a federal border officer, as they waited for the EMTs to arrive. The border guard said a feeling of calm immediately washed over him. And Jeremy later explained that he believed the incident may eventually help him process his own survivor's guilt and pain from his days in Iraq.
While he couldn’t do anything to save his fellow battle buddies, stepping from his car that April day in New York Jeremy realized he wasn’t helpless anymore. He rushed to the aid of another in dire need, with very little concern for himself, and in the process may have taken the first step to save himself, too.
Earlier this month, he received a Humanitarian Award for his actions that day. But why does it seem we need to wait for tragedies to take place to find ways to show our veterans how valuable they are?
Yes, our veterans need us to help them to transition back into our communities.
But we fail ourselves and them miserably if we neglect to understand and show just how badly we need them, too. Let’s work to find ways to tap into the important resources that our veterans are – not only in times of community or personal crisis, but in our everyday lives as well.
I salute all of those who wear or have worn that magical military uniform that is no less wondrous to me today as an adult than it was to me when I was a child peering into my father’s special closet.
Our veterans are among our greatest national assets. Let’s be there for them.
But let’s let them be there for us, too.
As you can see, I try to do a lot for our veterans.
That's fellow keynote speaker and enigmatic Iraq veteran and reporter Rick Scavetta with his sleeves rolled up immediately after the day's summit, Navy wife and NAMI-TN's Carol Roy giving the hard-working guy a back rub, and me in the back making sure Rick's jacket doesn't get dirty. NAMI-TN's Kenny Allred snapped the photo and added real muscle to the flat-tire changing operation -- just as you'd expect from another veteran.
NPT's Nashville conference was a companion to a PBS special airing that evening, "Depression: Out of the Shadows," our summit was the brainchild of the great folks at Nashville Public Television. As NPT's Kathy Edson explained with a smile, "We're not only on TV." The "multi-dimensional PBS project explores the complex terrain of depression, to help people understand this debilitating disease -- and find reasons for hope."
I will write a more thoughtful piece on what we learned at the gathering and plan to submit it to NAMI-TN for possible publication. In the meantime, enjoy some more photos courtesy of Kathy and Kenny...thank you all so much for planning and hosting such a remarkable event.
Tennessee is doing some remarkable things.
So glad to have had the chance to join with you and watch your plans take shape, bloom and hopefully grow.
The U.S. military says newly diagnosed cases of post-traumatic stress disorder [ptsd] among American troops sent to Iraq and Afghanistan climbed nearly 50 percent last year, bringing a five-year total to nearly 40,000.
Officials Tuesday released figures that showed Marines and Army soldiers were most affected. These are the forces bearing the brunt of combat in Iraq and Afghanistan. ...
Army Surgeon General Lieutenant General Eric Schoomaker says the larger number of diagnoses in recent years partly reflects greater awareness and tracking of the disorder by the U.S. military. But he says increased exposure of troops to combat is a factor. Experts have said symptoms increase as soldiers return to combat for multiple tours of duty.
Short clip from WCN:
Click on 'Article Link' below tags for more...
In educational interest, article(s) quoted from extensively.
Army soldiers committed suicide in 2007 at the highest rate on record, and the toll is climbing ever higher this year as long war deployments stretch on. At least 115 soldiers killed themselves last year, up from 102 the previous year, the Army said Thursday. Nearly a third of them died at the battlefront — 32 in Iraq and four in Afghanistan. But 26 percent had never deployed to either conflict.
"We see a lot of things that are going on in the war which do contribute — mainly the longtime and multiple deployments away from home, exposure to really terrifying and horrifying things, the easy availability of loaded weapons and a force that's very, very busy right now," said Col. Elspeth Ritchie psychiatric consultant to the Army surgeon general.
"And so all of those together we think are part of what may contribute, especially if somebody's having difficulties already," she told a Pentagon news conference. ...
The 115 confirmed suicides among active-duty soldiers and National Guard and Reserve troops who had been activated amounted to a rate of 18.8 per 100,000 troops — the highest since the Army began keeping records in 1980. Two other deaths are suspected suicides but still under investigation.
So far this year, the trend is comparable to last year, said Lt. Col. Thomas E. Languirand, head of command policies and programs. As of Monday, there had been 38 confirmed suicides in 2008 and 12 more death that are suspected suicides but still under investigation, he said. ...
Suicides have been rising nearly each year of the five-year-old war in Iraq and the nearly seven years of war in Afghanistan. The 115 deaths last year and 102 in 2006 followed 85 in 2005 and 67 in 2004. The rate of 18.8 per 100,000 last year compared to a rate of 17.5 in 2006 and 9.8 in 2002 — the first full year after the start of the war in Afghanistan.
The Centers for Disease Control and Prevention said the suicide rate for U.S. society overall was about 11 per 100,000 in 2004, the latest year for which the agency has figures. The Army said that when civilian rates are adjusted to cover the same age and gender mix that exists in the Army, the civilian rate is more like 19.5 per 100,000.
Defense Department studies show that suicides among all military personnel in Iraq, including Army, Navy, Air Force and Marine Corps personnel, occur at a rate of about 24 per 100,000, significantly above the civilian rate.
The new figures released by the Army show a 13 percent increase in suicides over 2006, when 102 soldiers took their own lives. ...
According to data gathered by the Army and other services over the past few years, the rising incidences of suicides and severe stress are directly related to the rigors of what Bush administration officials call "the Long War" in Iraq and Afghanistan.
The Defense Department has sought to increase training to prepare soldiers for the stress of combat, but most troops say the training is inadequate, according to an Army survey of over 3,000 soldiers in Iraq and Afghanistan last fall. ...
According to data released by the Army surgeon general earlier this week, the number of deployed soldiers diagnosed last year with the most severe combat stress, or post-traumatic stress disorder, jumped 46 percent over the number of new cases in 2006, an increase from 6,876 in 2006 to 10,049 in 2007.
Army researchers tied that finding directly to what they said was intensifying combat in Afghanistan and continued high levels of combat in Iraq.
In 2003, when the Iraq war was launched, just over 1,000 soldiers were diagnosed with PTSD. Since then, a total of 28,364 deployed soldiers had been diagnosed with PTSD through December 2007, according to the Army data.
Discouraging that the figures keep ratcheting upward, but sadly that's the reality we have to deal with. A final, but important, note made by Wood and echoed by many:
The data on military suicides and stress released this week are incomplete, Army officers acknowledged. For instance, the suicide data do not include soldiers who leave the Army and later develop mental health problems and often do not include National Guard soldiers who are demobilized after deployment.
Even within the combat zone, the Army's mental health advisory team reported this spring, "there is no single, joint tracking system capable of monitoring suicides, mental health evacuations and use of mental health and combat stress services."
Schoomaker, the Army's top medical officer, told defense reporters Tuesday that the Army does not systematically track soldiers who have lesser forms of stress than PTSD. ... He also acknowledged that the Army has inadequate facilities and too few mental health care providers to meet the need.
"As a nation, our mental health capability is not adequate to the need," and the Army suffers from the same problem, Schoomaker said. He said the Army recognized it is short 300 top mental health professionals to care for the growing numbers of soldiers suffering from severe stress. It has managed to fill only 180 of those positions, he said. ...
Based on its studies in the field, the Army expects that as many as 30 percent of soldiers will return from Iraq or Afghanistan with some symptoms of combat stress. Currently, there are about 155,000 troops in Iraq, including Army soldiers, Marines, Air Force and Navy personnel, and some 33,000 in Afghanistan.
Back to AP for a few more stats:
Other findings in the 2007 report included:
_93 of the 115 suicides were active duty troops; 22 were members of the Army National Guard or Reserve who had been mobilized.
_Five were women.
_In addition to completed suicides, there were 166 attempted suicides among troops in Iraq and Afghanistan and 935 over the whole Army.
_Young, white, unmarried junior enlisted troops were the most likely to attempt suicide.
_Firearms were the most common method for those who succeeded in killing themselves. Overdoses and cutting were the most common for all attempts.
_30 percent of all cases reportedly involved drugs and/or alcohol; rates were higher for failed attempts.
_The majority of people who committed suicide did not have known histories of mental disorders.
_Six percent of suicides and eight percent of attempts reportedly were among people who had prior diagnoses of post-traumatic stress disorder (PTSD).
_Fifty percent of soldiers who killed themselves had recently suffered a failed relationship with a spouse, girlfriend or other loved one.
_Seven percent of those who killed themselves — and of those who attempted to — had served multiple tours of duty to the wars.
_The highest number of attempts occurred among soldiers who were in the second quarters of their tours.
While a wide variety of events can trigger what's called post-traumatic stress disorder, this PTSD blog focuses solely on the combat-related variety. As a new generation of warriors returns to civilian life and seeks out resources, PTSD Combat is here to help.
"The first shamans earned their keep in primitave societies by providing explanations and rituals that enabled man to deal with his environment and his personal anguish. Early man, no less than we, dealt with forces that he could not understand or control, and he attempted to come to grips with his vulnerablity by trying to bring order to his universe." -- Richard Gabriel in No More Heroes
"War stories end when the battle is over or when the soldier comes home. In real life, there are no moments amid smoldering hilltops for tranquil introspection. When the war is over, you pick up your gear, walk down the hill and back into the world." -- OIF vet John Crawford in The Last True Story I'll Ever Tell
"After wars' end, soldiers once again become civilians and return to their families to try to pick up where they left off. It is this process of readjustment that has more often than not been ignored by society. -- Major Robert H. Stretch, Ph.D in Textbook of Military Medicine: Vol. 6 Combat Stress
Upcoming Events
Ilona's events are listed in green and found here.
October 22-November 15, 2009 in Milwaukee, WI - Milwaukee Art Museum hosts War, Art, & the Veteran, a display of artworks created by combat veterans.
November 5-11, 2009 in DeKalb, IL - Northern Illinois University Veterans Club hosts a number of Veterans Day events, including its first Veterans Club Community Roundtable and its own Vet Art Project. See Ilona's events and facebook events page for more.
November 25, 2009 in Chicago, IL - Vet Art Project program at the Chicago Cultural Center. See schedule [pdf] for more.
December 9, 2009 in Chicago, IL - Vet Art Project program at the Chicago Cultural Center. See schedule [pdf] for more.
December 6-5, 2009 in Warwick, UK - MindGrad 2009 Warwick Graduate Conference in the Philosophy of Mind. Call for papers deadline: Sept. 1 | Registration.
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