Trauma of War — (Albuquerque Journal)

SSRI Ed note: Veteran's Affairs kills another talented young soldier with polypharmacy: antidepressants, pain killers, tranquilizers, muscle relaxers.

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Albuquerque Journal

By Charles D. Brunt, Journal Staff Writer

Senior Airman Anthony “Tony” Mena managed to dodge bullets, rocket-propelled grenades and roadside bombs during two tours in Iraq.
But he couldn’t survive the onslaught of medications a string of military, Veterans Affairs and civilian doctors prescribed to treat his resulting post-traumatic stress disorder and back pain.
Five months after being medically discharged, Mena, a former member of Kirtland Air Force Base’s 377th Security Forces Squadron, died in his sleep — the result of a lethal mix of nine prescribed medications, including antidepressants, pain killers, tranquilizers and muscle relaxers.

The medical examiner ruled the 23-year-old’s death an accident: Mena had not taken more medicine than prescribed — just what the doctors had ordered.
His July 21, 2009, death in his Albuquerque apartment set his family on a quest to force changes in PTSD treatment.
“I trusted the doctors,” his mother, Pat Mena, said last week from her El Paso home. “I really thought they had a list of everything my son was taking.”
Those doctors included military, VA and private physicians and psychiatrists who, in her estimation, did little to coordinate the 29 drugs they prescribed for her son during the 18 months he sought help for his PTSD.

Mena and two other servicemen who died under nearly identical circumstances were the subjects of a recent New York Times story about the military’s dependence on drug therapy to treat PTSD.

Post-traumatic stress disorder is a severe anxiety disorder that produces psychological symptoms that can occur after a person experiences a traumatic event. It can cause flashbacks, nightmares, depression, anxiety, edginess, substance abuse and other symptoms, and it can surface years after the event that caused it.

Some studies indicate that 20 percent of returning Iraq and Afghanistan troops have PTSD.
Mena’s case, and too many like it, has prompted the military to revise its policies on polypharmacy — the use of combinations of multiple medications. Military studies have cited polypharmacy as a factor in the Army’s burgeoning suicide rate and in fatal accidents like the one that claimed Mena.
In November, the Office of the Surgeon General/U.S. Army Medical Command released new polypharmacy guidelines that, among other requirements, call for 30-day prescription limits on certain medications, reviews of cases where soldiers are prescribed four or more drugs, and better training of clinicians.
For the Mena family, all that came too late.
“Our son can no longer be with us. We can never bring him back,” Pat Mena said. “But I’m hoping we can raise awareness of this over-medication of our kids.”

Multiple drugs are common

Dr. Gerardo Villarreal, staff psychiatrist with the New Mexico Veterans Affairs Health Care System at the Raymond G. Murphy VA Medical Center — where Mena had been treated — said it’s not uncommon for a PTSD patient to be prescribed multiple drugs.
“It is very common, especially among those with combat PTSD, to be prescribed multiple medications. It’s a very serious condition that is difficult to treat,” Villarreal said last week.
Villarreal said that only two drugs are approved by the federal Food and Drug Administration to treat PTSD — Sertraline and Paroxetine.
Frequently, however, PTSD patients need more than Sertraline or Paroxetine to treat their symptoms. For example, he said, a physician might prescribe drugs to treat insomnia or nightmares.
A PTSD patient’s meds list can grow even longer if they suffered other injuries.
In Mena’s case, for example, he was prescribed pain killers for his back injury, his mother said.
Barred by medical privacy regulations, Villarreal could not discuss individual cases.
PTSD treatment is branching out beyond pharmacology and psychiatry, Villarreal said, into such areas as yoga, meditation, tai chi and, more recently, acupuncture.
The most successful PTSD treatments, he said, appear to be exposure-based treatments, in which the patient, under medical supervision, talks repeatedly and in great detail about the trauma that triggered the PTSD.
“But not everyone is able, or willing, to do those treatments. It’s very stressful,” he said. “They have to talk frequently about the traumatic events, write them down and read it over and over, when the normal tendency is to avoid reliving the event.”
But if a patient opts to seek medical help outside the VA, and fails to tell either doctor that they’re seeing another physician, both doctors might be unaware what the other has prescribed, Villarreal said.
That could result in multiple medications and dangerous drug interactions, he said.
“One advantage of the VA system is that we have electronic medical records,” Villarreal said. “When I see a patient, I see everything. I see all of their medications. I see notes from all the providers, lab reports, test results. If I prescribe a medication and there is a known interaction, the computer will send me a warning. We know exactly what’s going on with the patient.”

Iraq: two tours

A month after graduating from El Paso’s Eastwood High School, Tony Mena reported for basic training at Lackland Air Force Base in San Antonio, Texas. Fulfilling a longtime dream of becoming a military policeman, he was assigned to the 377th Security Forces Squadron at Kirtland Air Force Base.
Against his mother’s wishes, he volunteered to deploy to Iraq and, from July 2005 until January 2006, he was doing security work at a base in Mosul. Although he described his initial six-month tour as “uneventful,” his mother said he had trouble sleeping when he returned stateside and was prescribed sleeping pills.
Ten months later, he returned to Iraq where, working alongside Army soldiers, he helped train Iraqi police forces in Baghdad.
As part of his duties, Tony planned and conducted patrols through Baghdad’s volatile neighborhoods, often as the lead driver in a convoy of armored Humvees.
The convoys often showed up at the scenes of suicide bombings and IED blasts, and were sometimes tasked with collecting bodies — and parts of bodies — and attempting to identify victims, his mother said.
“These young men saw things that stay with them,” she said. “They see horrible things we will never see.”
When her son returned home in late 2007, “something had changed,” his mother said.
The usually astute airman was impatient, forgetful and irritable, and he often cut short phone conversations with his family, which was very uncharacteristic. His once regular visits home to El Paso became less and less frequent.
When things didn’t improve, his parents drove to Albuquerque for a visit in the summer of 2008 and learned that Tony had been diagnosed with PTSD, was taking a list of prescribed drugs and seeing a psychiatrist. But nothing seemed to reverse his depression, Pat Mena said.
Exacerbating the PTSD symptoms were back problems that military doctors insisted were “in his head,” she said. Civilian doctors eventually discovered a lower-back injury that had healed improperly and added muscle relaxants and powerful pain killers to Tony’s growing list of pharmaceuticals.
Within a year, Tony refused to go anywhere without his backpack of meds. He started having unexplained memory lapses and other side effects.
“They changed out his medications over and over,” Pat Mena said, making it nearly impossible for Tony to remember which medications to take when.
“All they were doing was over-medicating him,” she said. “They were just throwing pills out.”
Family: Get the message out
The medications, their side effects and Tony’s recurring PTSD symptoms made it impossible for him to perform his military duties, and Air Force officials assigned him to “a desk job,” his mother said.
“He hated it,” she said. “He was miserable, he was depressed and he had terrible nightmares.”
Knowing he could no longer do the job he loved, Tony accepted a medical discharge and left the Air Force in February 2009. But he opted to stay in Albuquerque.
“He loved Albuquerque,” Pat Mena said. “I wanted him to come home and live here in El Paso, but his friends were there, his doctors were there and his girlfriend was there.”
Now under VA health care, Tony began seeing new doctors, who recommended a three-week PTSD treatment in Tucson, which seemed to do more harm than good, his mother said.
“They changed out his medications, which led to withdrawal symptoms,” including a seizure, she said. After consulting his regular psychiatrist, Tony was put back on his previous medications.
Although he showed signs of improvement over the next few weeks, the mixture of medications wrote Tony’s final chapter.
Now his family won’t rest until steps are taken to prevent similar tragedies.
“We want to get across the message that they are over-medicating our troops,” Pat Mena said. “They need to question the doctors about what they’re taking, whether they’re really necessary, and what the side effects are. Tony suffered from a lot of side effects and with so many drugs, it was impossible to find out which ones were causing his chills, urinary problems, sweating, insomnia, nausea, headaches — all these side effects.”
“I just can’t believe that’s the way they’re treating our troops,” she said. “It’s not necessary. There’s got to be a better way.”
“I don’t think any of us want to blame anybody,” said Bobby Mena, one of Tony’s two older brothers. “We just want to get the story out there and let other people know what’s going on and how it can be prevented. What happened to my brother didn’t have to happen — it could have been prevented.”
Mena’s family has set up a memorial website at