Some troops in Iraq take sleep aids, antidepressants

Some U.S. troops in Iraq are taking antidepressants such as Prozac™, Zoloft™ and Paxil™, as well as mild sleeping aids, to help them cope with the stresses of long separations and combat duty, according to a top military psychiatrist and treating doctors.

Army Col. (Dr.) Elspeth Cameron Ritchie, an associate professor of psychiatry at the Uniformed Services University of the Health Sciences, said she could not provide numbers on how many troops have been prescribed the medications.

However, she said anecdotal reports she has received indicate the medications are working well. She said troops also should be receiving a balance of care, including counseling, which she believes is happening.

Dr. Michael Kilpatrick, a retired Navy captain who serves as deputy director of the Pentagon’s Deployment Health Support Directorate, said taking antidepressants does not disqualify someone from deployment; a patient’s overall condition determines that.

The Pentagon has no policy governing the use of mental health drugs in theater, said senior health officials.

Decisions on whether a service member deploys are based on each individual’s case, including his or her stability and the availability of follow-up care. Taking medications that require regular monitoring, for example, would disqualify someone for deployment if the necessary laboratory equipment was not available in theater.

Determining the scope of mental-health drug use among troops in the war zone is difficult. There is no central database, electronic or otherwise.

Both the U.S. Central Command, which has oversight of the Iraq and Afghanistan war zones, and the individual services say they do not track the use of such drugs.

Army Col. (Dr.) Christopher White, state surgeon for the Iowa Army National Guard, served at the Troop Medical Clinic at Logistic Support Area Anaconda in Iraq from May to December 2003. White estimated that about 3 percent of the soldiers he and other doctors treated there were using mental health medications, mostly drugs called selective serotonin reuptake inhibitors, such as Paxil and Zoloft.

“It’s pretty much reflective of about the same percentage of the general population,” White said.

About half the troops taking antidepressants arrived in theater with the prescriptions. About half of those had been using the drugs for a couple of years, while the rest had begun taking them only months prior to deployment, which White said leads him to believe the latter group started them as a result of deployment-related stress.

Army Col. (Dr.) W. Joseph Horam, state surgeon for the Wyoming Army National Guard, handled primary care at LSA Anaconda from July through October. The figure of 3 percent for troops using antidepressants was about right, he said.

Horam initiated treatment for some troops in theater. “If they’re functional and you often have a sense they’re doing their job … sometimes the SSRIs are very useful,” he said.

Most of the troops taking antidepressants were doing so to help them cope with separation problems and stresses of the war-zone environment, Horam said.

Patients must be closely followed for several months after they begin taking the drugs because there is a higher risk of worsening symptoms during that time, including suicidal thoughts.

“You wouldn’t want to treat them arbitrarily,” Horam said. “You want to treat people who have access to follow-up [care]. These medications can’t be used in a vacuum.”

Some troops suffered from acute sleep deprivation rather than depression or anxiety. In those cases, Horam would place them in quarters for several days and prescribe a mild sleep aid.

February 28, 2005 By Deborah Funk Army Times staff writer.

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