Managing Medications for Mental Health in Military Personnel

Military life is thought to be a risk factor for psychiatric problems such as posttraumatic stress disorder (PTSD), depression, generalized anxiety disorder, and panic disorder, because of working in high pressure and stressful environments.¹ The use of psychotropic medications in the military can be associated with the presence of a psychiatric issue that requires ongoing treatment. In recent years, there has been a growing movement towards limitations or restrictions placed on the use of psychotropic medications, which can be used to manage more severe mental illnesses, among active-duty military personnel.²

The misuse of psychoactive prescription medication can prove to be dangerous and, in some cases, deadly, so special care is being taken to closely monitor prescribing and use of these therapies. The mixture of certain psychoactive medications with others can also prove to be disastrous, which is another reason why steps are being taken to provide appropriate education to military personnel and to monitor utilization. As such, there has been growing adherence to prescribing practices for military-related PTSD and other mental disorders, which follow the US Veterans Health Administration (VHA) and Department of Justice clinical guidelines.

Although there has been an observed increase in the use of psychotropic medication among the general population, it has not been confirmed if this also has been observed with military personnel. However, according to a 2013 Military Times report, an investigation of records showed $1.1 billion was spent by the Defense Logistics Agency on common psychiatric drugs and pain medications from 2001 to 2009. Antidepressants and anticonvulsants were the most commonly prescribed medications for service members with mental health conditions, at the time of the report.³

Additionally, these medications are more likely to be shared and traded within combat zones. In order to curtail this growing practice, the extent of the problem has to be identified.⁴

A 2016 published study examined US veterans who had served in overseas conflicts and received a diagnosis of PTSD at the VHA between 2008 and 2011. Investigators found that 80% of veterans who are diagnosed with PTSD or other mental conditions received some type of pharmacological treatment, and about 79% receive prescriptions for antidepressants.⁵ Given the significant use of these psychotropic medications, it is critical that military personnel are thoroughly informed about proper administration, adverse effects, and possible interactions when these drugs are mixed with others.

A more recent study, published in 2021, examined the potential effect of service dogs on mitigating medication regimens for veterans diagnosed with PTSD. Study participants included veterans living with a service dog, and those on a waiting list. According to investigators, both groups completed a survey of self-reported therapy regimens and medication changes, and regression models were used to analyze how physical health, mental health, pain, and sleep medications might be quantified with utilization of a service dog. Confounding variables such as age, gender identity, relationship status, traumatic brain injuries, and physical health also were considered.⁶

Although this study found that the service dogs had no significant effect on medication use, veterans with a therapeutic canine companion were more likely than those on the waitlist to report that their doctor had decreased dosage or removed drugs from their regimen since receiving their service dog. According to investigators, additional research is needed to better understand the potential correlation between service dogs and medications for PTSD management.⁶

Overall, pharmacists who work with veterans can provide sound and quality counseling that will adequately educate military personnel of both the benefits and the risks associated with the use of psychotropic medications. Pharmacists can be instrumental in helping to curtail the prevalence of psychotropic medication misuse while also providing unique expertise on drug information. The appropriateness of medication prescribing, along with ongoing education, may serve to decrease the rates of medication misuse that can occur among military personnel.

REFERENCES

1. Janseen D, Vermetten Ek, Egberts TCG, Heerdink ER. Prevalence of psychiatric medication use among Dutch military personnel between 2003 and 2012 and its comparisons to the Dutch general population. Mi Med, 2017;182(1-2),1584.
2. Military limits use of antipsychotics medications to treat soldiers with PTSD.Partnership to End Addiction. May 2012. Accessed June 10, 2021. https://drugfree.org/drug-and-alcohol-news/military-limits-use-of-antipsychotic-medications-to-treat-soldiers-with-ptsd/
3. Medicating the military-use of psychiatric drugs has spiked, concerns surface about suicide, other dangers. Military Times. Published March 29, 2013. Accessed June 10, 2021. https://www.militarytimes.com/2013/03/29/medicating-the-military-use-of-psychiatric-drugs-has-spiked-concerns-surface-about-suicide-other-dangers/
4. Morasco BJ, Dobscha SK: Prescription medication misuse and substance use disorder in VA primary care patients with chronic pain. Gen Hosp Psychiatry, 2008; 30(2): 93–9.
5. Harpaz-Rotem I,Rosenheck R, Mohamed S et al. Initiation of pharmacotherapy for post-traumatic stress disorder among veterans from Iraq and Afghanistan: A dimensional, symptom cluster approach. BJPsych Open. 2016; 2:286-293
6. Rodriguez KE, Anderson LM, Ott CA, O'Haire ME. The effect of a PTSD service dog on military veterans’ medication regimens: a cross-sectional pilot study. Anthrozoös, 34:3, 393-406, DOI: 10.1080/08927936.2021.1898219