Long-Term Outcomes of Antipsychotic Medication Use in Veterans with PTSD
Abstract
The rates of posttraumatic stress disorder (PTSD) in military personnel and Veterans are significantly higher than in civilians. Within active-duty military Service Members the rates per 1,000 Service Members have been increasing from a low of 1.24 in 2002 to a high of 12.94 in 2016 (Judkins et al., 2020) and 11%-20% of Veterans are diagnosed with PTSD whereas the rate of PTSD in the civilian population is about 6%. Despite this highly prevalent problem, less than one-third of Veterans treated with the most effective treatments for PTSD (i.e., Prolonged Exposure therapy and Cognitive Processing therapy) improve significantly. Accordingly, additional treatments for PTSD are desperately needed. Antipsychotic medications are frequently prescribed for Veterans with PTSD even when they do not have a diagnosis for which there is U.S. Food and Drug Administration (FDA) approval (e.g., schizophrenia, bipolar disorder). Indeed, there is some evidence that select antipsychotic medications improve secondary outcomes relative to placebo including reducing PTSD and depression symptoms, although the evidence for these effects is currently considered weak (Williams et al., 2022). Additional evidence suggests that antipsychotic medications may reduce PTSD-related sleep disturbances (Nicholson et al., 2021) and since sleep disturbance is known to partially explain the link between PTSD and suicidal ideation (Rohr et al., 2021), improving sleep may reduce mental health hospitalization and improve long-term outcomes in Veterans with PTSD. Recent clinical practice guidelines caution against the use of antipsychotic medications for PTSD, presumably due to the limited research supporting their usefulness and the risk of negative side effects that impact cardiometabolic health. The most concerning side effects of antipsychotic medications are weight gain and risk for metabolic syndrome (e.g., diabetes and hypertension) that could lead to cardiovascular disease. The concern about these side effects is legitimate as weight gain and metabolic syndrome can lead to long-term medical problems and even premature death. Surprisingly, the long-term consequences of antipsychotic medications in Veterans remain unknown. That is, whether antipsychotic medications impact the rate of hospitalization or death in Veterans has, to our knowledge, never been studied. Such studies would allow for the relative benefits (e.g., reduction in mental health hospitalizations) to be considered in light of relative risks (e.g., weight gain that increases the likelihood of hospitalization for medical conditions such as diabetes and heart disease). However, because of the unknown risks and high costs of long-term research studies, it is not feasible to conduct purpose-built clinical trials to study these questions. Examination of the nationwide Department of Veterans Affairs (VA) medical record in its entirety can provide opportunities for research that would otherwise be difficult to attain in the civilian setting. In this case, use of Veteran medical records will allow for important research questions to be examined about the long-term consequences of antipsychotic medications in Veterans with PTSD. Specifically, we have found that over 1.3 million Veterans have been prescribed antipsychotic medications since 2000. Of those, 47,415 had diagnoses of PTSD and no other condition for which antipsychotic medications have been FDA-approved. Careful examination of these data will provide evidence of the rates of hospitalization and death in Veterans with PTSD who are versus those who are not prescribed antipsychotic medications. Moreover, data about the specific cause of hospitalization (i.e., for mental health or for consequences of cardiovascular disease) will allow the balance in long-term risks and benefits to be examined for the first time. Even more importantly, we have found that only a proportion of Veterans prescribed antipsychotics actually experienc
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Jan 04, 2024
- Source ID
- HT94252310902
Entities
People
- John Mcgeary
Organizations
- Ocean State Policy Research Institute
- United States Army