Did military withhold correct treatment for mentally ill? — (The Philadelphia Inquirer)

SSRI Ed note: Army veteran on Effexor commits suicide,. Lack of counselling blamed.


Original article no longer available

The Philadelphia Inquirer

Posted on Mon, May. 22, 2006

By Lisa Chedekel and Matthew Kauffman

Troops got antidepressants but not needed counseling
When Army Sgt. First Class Mark C. Warren, of La Grande, Ore., was diagnosed with depression soon after arriving in Iraq, a military doctor gave him the mood-altering drug Effexor.
Marine Pfc. Robert Guy, of Willards, Md., was given Zoloft to relieve the depression he developed in Iraq.
And Army Pfc. Melissa Hobart, of East Haven, Conn., received Celexa for the anxiety of missing her young daughter while in Baghdad.
Each is among a growing number of mentally troubled service members treated in combat with potent psychotropic medications but with little or no medical monitoring or mental health counseling.
Warren, 44, and Guy, 26, committed suicide last year, according to the military; Hobart, 22, collapsed and died in June 2004, of a still-undetermined cause.
Interviews with troops, families and medical experts, as well as autopsy and investigative reports reveal that the military’s attempts to retain troops with psychological problems has had dangerous consequences.
The practice is at odds with the military’s medical guidelines, which state that certain mental illnesses and medications are incompatible with deployment to combat. It also conflicts with statements by top military health officials, who have told Congress that psychiatric drugs are not being used to keep service members with serious disorders in combat.
Military officials insist that their use of medications is judicious and argue that keeping troubled troops close to the front lines is in the service members’ best interests, because it helps them avoid the stigma of abandoning their duty.
But many outside the chain of command see it differently.
“It’s best – for the Army,” said Paul Rieckhoff, a former platoon leader in Iraq who said he was overruled when he tried to have a mentally ill soldier evacuated. “But find me an independent mental health expert who thinks that that’s a proper course of action.”
Drugs in a class known as SSRIs, such as Zoloft, Prozac, Paxil and Celexa, are the most common antidepressants. They can worsen depression and increase suicidal thinking in depressed patients, and the Food and Drug Administration says patients taking any antidepressant medication should be monitored carefully when the drugs are first prescribed – a task that can be hard in a war zone.
Some Iraq war veterans say antidepressants and sleep aids were relatively easy to obtain, with no counseling.
Paul Scaglione, 23, an Army mechanic from near Detroit, said he took Wellbutrin in 2003.
“It was no big deal,” he said. “They just talk to you a little… but they don’t follow up or anything.”
Col. Elspeth Ritchie, psychiatry consultant to the Army Surgeon General, insisted that psychiatric drugs were being used “judiciously and carefully” and that troops received a “balance of care,” including counseling.
Exactly how many troops take psychiatric drugs remains a mystery. In response to a Freedom of Information Act request by the Courant, officials released only limited records.
But those records, and the Army’s own reports, show that the use of psychiatric drugs in Iraq has increased steadily. A 2004 report by Army mental-health professionals found widespread complaints from combat doctors about a lack of psychotropic drugs, which prompted the military to approve making antidepressants, including Prozac, and Zoloft, more available. A follow-up report 13 months later cited no such complaints.
In a little-noticed change a year ago, the Army revised its deployment guidelines to caution against deploying troops on antidepressants for “moderate to severe” depression.
William Winkenwerder Jr., the assistant secretary of Defense for health affairs, told Congress last summer that the military allowed troops to deploy on psychotropic drugs if they were on a maintenance dose after a condition had “fully resolved.”
How the military interprets “fully resolved” is in question.
“We have seen people diagnosed within three to four weeks [before] deployment, put on medications like Paxil, and their deployment schedule rolls along,” said Kathleen Gilberd, a San Diego legal counselor for service members.
Ritchie acknowledged that the practice serves the military.
“Historically, we’ve found patients evacuat© 2006, HARTFORD COURANTed out of theater don’t return,” Ritchie said, “and then it’s a loss of manpower for the service.”