Combat Cocktail: Are PTS meds doing more harm than good?

Phil Briggs
March 30, 2018 - 11:49 am

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Some veterans have called it the “combat cocktail.” A combination of drugs prescribed to combat vets for a variety of conditions including PTS, anxiety, depression and pain.

But could these drugs, unintentionally, make their patient's condition worse?

The recent tragedy at The Pathway Home in Yountville, CA, where Albert Wong, a former Army rifleman, killed hostages and then himself, demonstrates just how important veteran’s care and overall mental health issues are today. As we mourn the loss and salute the heroism of Christine Loeber, executive director, Dr. Jen Golick, a therapist and Dr. Jennifer Gonzales, a psychologist, we reach for answers.

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Also reaching for answers is Iraq War veteran, author and warfighter right’s activist, Boone Cutler.  A former paratrooper with the Army’s 82nd Airborne Division, Cutler fought in Sadr City, one of the deadliest neighborhoods in Baghdad. The action he witnessed will never be forgotten and is chronicled in the book, "Voodoo in Sadr City." After surviving a blast that required medical evacuation, Cutler endured a two-year recovery from wartime injuries at Walter Reed Army Medical Center and ongoing therapy for PTS.   

Shortly after The Pathway Home tragedy, Cutler raised some important questions: “The next step is we gotta look at is what drugs he was on…over and over again in our society we’re seeing these tragedies, these shootings, and the common denominators are, one, there’s a firearm involved and two, there’s some sort of psychiatric medication involved. And I can say from personal experience, coming back from Iraq, being diagnosed with PTSD, being on all the PTSD medications that big pharma provides … I can tell you for a fact that during that time I was more violent, and less apt to seek help … when I was on those drugs.”

According to the Veterans Affairs website, the drugs most commonly used for the treatment of PTS are antidepressants, called SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin-norepinephrine reuptake inhibitors).

The four antidepressants effective for treating PTS are SSRI like Sertraline (Zoloft), Paroxetine (Paxil), Fluoxetine (Prozac) and SNRI’s like Venlafaxine (Effexor).

“Irritability is a known side effect of SSRI’s and SNRI’s and so they really have to be followed closely,” says Dr. John Bradley, Chief of Psychiatry and Deputy Director, Mental Health Service of the VA Boston Healthcare System.

But,is it documented anywhere in medical observation, that these drugs could actually cause patients to become more violent? 

Dr. Bradley explained, “It is, and there are numerous case reports of individuals behaving violently or aggressively…and what we know is, that it's both: a symptom of PTSD- feeling angry, irritable or on edge; as well as a potential side effect of some of the medications.”

Bradley discussed how SSRI’s and SNRI’s can also have sexual side effects such as “decreased libido, erectile dysfunction and delayed orgasm. Sexual side effects can occur in, “anywhere from 25-75 percent of people taking these medications for both men and women.”

Bradley also acknowledged a time when anti-anxiety medications known as benzodiazepines were used for PTSD. “They’ve been around for a long time and were the foundation of treatment for anxiety disorders.” He explained, there has been a shift away from these meds for good reason, “What we’ve seen is that benzodiazepines actually seem to worsen the course of PTSD.”

With the potential for such severe side effects, Dr. Bradley offered some important advice, “It’s really important when engaging in treatment, to have a really open dialogue with your treating psychiatrist or physician about the symptoms you're having and what the potential side effects are.”

 Bradley explained he doesn’t want to scare or dissuade a patient from considering this medication, but rather “have an open dialogue, so that should any of these occur, we can talk about them here and decide how best to manage them.”

Ask Army veteran Boone Cutler about how these drugs can affect a war fighter and you’ll get an even more direct answer, “I have not seen a warfighter yet, who took their own life, who was not taking benzodiazepines! It says right on the black box …may cause suicide.”

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So, with the potential for such severely negative side effects, how does Cutler manage today?

“The big thing I do now is use cannabis,” he said. “And every war fighter I know that uses cannabis does not have the issue of being more violent, and less reasonable…this is what we want!”

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Bradley added, “I’ve had many patients before, report that cannabis has helped them, and for those patients I’m happy to discuss how they’ve used the cannabis, and how that’s going to impact the other treatments we decide to do together. My job as a physician is to help share with them what the evidence is, what the risks may be, and allow them to make the decision that’s right for them.” 

But until the DOJ, and Congress actually remove the legal handcuffs from the VA, and allow them to start doing meaningful marijuana research, veterans like Cutler (and those that survive the meds) will continue to ask, “What is in the chemical combat cocktail, that is causing these problems, and why aren’t people taking the steps to make it stop?” 

 

Also read:  Blowing Smoke: Who is lying to Veterans about medical marijuana?