VA still giving addictive drugs for PTSD

Veterans treated at Veterans Affairs Department medical facilities for post-traumatic stress disorder often receive highly addictive sedatives even though the department’s own guidelines issued in 2010 recommend against their use for the condition.

A recent VA study found that nearly a third of veterans diagnosed with PTSD at VA have a prescription for a benzodiazepine such as Valium, Xanax or Ativan despite concerns over addiction potential and withdrawal symptoms that can include panic attacks, anxiety and sleeplessness.

VA and Defense Department clinical practice guidelines published three years ago cautioned doctors against prescribing the tranquilizers for PTSD because there is no proof they are effective.

But physicians still write prescriptions for the drugs, once considered a front-line PTSD treatment, because they can help reduce symptoms such as anxiety and insomnia and also have a reputation among some physicians for accelerating effectiveness of other accepted PTSD drugs, such as SSRIs, according to Nancy Bernardy, lead author and associate director of clinical networking at the National Center for PTSD.

“Many physicians believe they provide benefits in terms of both speed of response as well as overall response,” Bernardy noted in an article published in VA’s PTSD Research Quarterly.

The 2010 guidance warns that benzodiazepine use is discouraged or should be used “with caution” because some studies suggest the drugs may interfere with how patients deal with fear and might actually delay recovery.

Extreme care should be taken when prescribing them to combat veterans with PTSD, the authors noted, because these veterans are more susceptible to developing a substance abuse disorder than patients whose PTSD was caused by another type of trauma.

The number of veterans being treated for PTSD at VA has nearly tripled from 171,000 in 1999 to nearly 500,000 in 2009. Most patients during that time frame — 80 percent — were prescribed a medication recommended by the clinical practice guidelines, according to the report, and the department actually saw an overall drop in the rate of benzodiazepine prescriptions for PTSD patients during that period, down from 37 percent in 1999 to 30 percent in 2009.

The decline is promising, Bernardy noted, but since “the frequency of use remains high, [it] suggests that minimizing benzodiazepine exposure is a vital policy issue for VA.”

Researchers said new medications added to the VA pharmacy formulary in the past five years, such as Ambien and prazosin, can ease PTSD-associated insomnia and anxiety and are now more widely prescribed to veterans for PTSD. Their growing use might lead to a further drop in benzodiazepine prescriptions.