Improving Care for Veterans with PTSD: Comparing Risks and Benefits of Antipsychotics versus Other Medications to Augment First-Line Pharmacologic Therapy
Abstract
Relevance to Peer Reviewed Medical Research Program (PRMRP) Topic Areas: The goal of this project is to use national Veterans Affairs (VA) healthcare data to determine the benefits and risks of use of antipsychotic medications to augment first-line medication therapy in patients with post-traumatic stress disorder (PTSD). This work is directly addresses the PRMRP topic area of Psychotropic Medications with goals to conduct "research into the use of psychotropic medications for the treatment of mental health disorders including post-traumatic stress, suicidal ideation, substance abuse, and other co-morbid disorders." Background/Objectives: The overall goal of our research program is to improve the health and quality of life of Service members and Veterans with post-traumatic stress disorder (PTSD). To date, over 2.5 million American men and women have served in support of the military operations in Iraq and Afghanistan. PTSD is the most commonly diagnosed mental health disorder in Veterans, with nearly 1 in 3 returning Iraq and Afghanistan Veterans seen in VA care receiving this diagnosis. In addition to counseling therapies, several medications are effective in treating PTSD symptoms. However, clinical trials show less than 30% of patients will achieve remission of PTSD symptoms with these treatments. Therefore, providers and patients will look for additional medications to augment therapy. Antipsychotic medications are Food and Drug Administration-approved and beneficial for the treatment of bipolar disorder and psychotic disorders, such as schizophrenia. However, they have been increasingly prescribed "off-label" for non-approved conditions, such as PTSD. In a prior study, we found that 1 in 5 returning Iraq and Afghanistan Veterans with PTSD seen in VA care were receiving an antipsychotic medication in the absence of one of the approved conditions. This is occurring despite VA and Department of Defense guidelines that discourage the use of antipsychotics for PTSD treatment because there is still considerable debate about whether antipsychotic medications are safe and effective in PTSD. Unfortunately, prior trials of antipsychotics typically included Veterans that were substantially older than our returning Veterans and almost no women were included. In addition to questions about their benefits, antipsychotics have concerning metabolic side effects, including increases in weight, cholesterol, and blood sugar that can lead to serious problems like diabetes and heart disease. Therefore, we urgently need to better understand the risks and benefits of their use in returning Veterans with PTSD. Ideally, we would conduct a large clinical trial comparing antipsychotics to placebo in this population, but this would take many years and millions of dollars to complete. Further, only a small subset of patients will volunteer and qualify for clinical trials, and they are usually very different from the many patients who may later get prescribed these drugs. Fortunately, we have detailed medical information on tens of thousands of returning Veterans with PTSD who are entering VA care. We propose to use these records to compare the effects of antipsychotics versus other types of psychiatric medications to determine: Objective 1: Metabolic outcomes, including changes in body mass index, cholesterol, blood pressure, and blood sugar; new diagnoses of obesity, cholesterol problems, high blood pressure, and diabetes; and use of additional medications to treat these problems. Objective 2: Mental health outcomes, including changes in PTSD symptoms, emergency room visits or hospitalizations for psychiatric problems, and suicidality. Objective 3: Gender and racial differences in the risks and benefits of antipsychotic use. Applicability and Impact: This research is directly applicable to the hundreds of thousands of returning Veterans struggling to deal with PTSD symptoms. It will help them, their families,
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Jan 31, 2017
- Source ID
- W81XWH1610210
Entities
People
- Beth Cohen
Organizations
- United States Army
- VA Boston Healthcare System