More than 110,000 active-duty Army troops last year took antidepressants, sedatives and other prescription medications. Some see a link to aberrant behavior.
SEATTLE < U.S. Air Force pilot Patrick Burke’s day started in the cockpit of
a B-1 bomber near the Persian Gulf and proceeded across nine time zones as
he ferried the aircraft home to South Dakota.
Every four hours during the 19-hour flight, Burke swallowed a tablet of
Dexedrine, the prescribed amphetamine known as “go pills.” After landing, he
went out for dinner and drinks with a fellow crewman. They were driving back
to Ellsworth Air Force Base when Burke began striking his friend in the
head.
“Jack Bauer told me this was going to happen < you guys are trying to kidnap
me!” he yelled, as if he were a character in the TV show “24.”
When the woman giving them a lift pulled the car over, Burke leaped on her
and wrestled her to the ground. “Me and my platoon are looking for
terrorists,” he told her before grabbing her keys, driving away and crashing
into a guardrail.
Burke was charged with auto theft, drunk driving and two counts of assault.
But in October, a court-martial judge found the young lieutenant not guilty
“by reason of lack of mental responsibility” < the almost unprecedented
equivalent, at least in modern-day military courts, of an insanity
acquittal.
Four military psychiatrists concluded that Burke suffered from
“polysubstance-induced delirium” brought on by alcohol, lack of sleep and
the 40 milligrams of Dexedrine he was issued by the Air Force.
In a small but growing number of cases across the nation, lawyers are
blaming the U.S. military’s heavy use of psychotropic drugs for their
clients’ aberrant behavior and related health problems. Such defenses have
rarely gained traction in military or civilian courtrooms, but Burke’s case
provides the first important indication that military psychiatrists and
court-martial judges are not blind to what can happen when troops go to work
medicated.
After two long-running wars with escalating levels of combat stress, more
than 110,000 active-duty Army troops last year were taking prescribed
antidepressants, narcotics, sedatives, antipsychotics and anti-anxiety
drugs, according to figures recently disclosed to The Times by the U.S. Army
surgeon general. Nearly 8% of the active-duty Army is now on sedatives and
more than 6% is on antidepressants < an eightfold increase since 2005.
“We have never medicated our troops to the extent we are doing now…. And I
don’t believe the current increase in suicides and homicides in the military
is a coincidence,” said Bart Billings, a former military psychologist who
hosts an annual conference on combat stress.
The pharmacy consultant for the Army surgeon general says the military’s use
of the drugs is comparable to that in the civilian world. “It’s not that
we’re using them more frequently or any differently,” said Col. Carol
Labadie. “As with any medication, you have to look at weighing the risk
versus the benefits of somebody going on a medication.”
But the military environment makes regulating the use of prescription drugs
a challenge compared with the civilian world, some psychologists say.
Follow-up appointments in the battlefield are often few and far between.
Soldiers are sent out on deployment typically with 180 days’ worth of
medications, allowing them to trade with friends or grab an entire fistful
of pills at the end of an anxious day. And soldiers with injuries can easily
become dependent on narcotic painkillers.
“The big difference is these are people who have access to loaded weapons,
or have responsibility for protecting other individuals who are in harm’s
way,” said Grace Jackson, a former Navy staff psychiatrist who resigned her
commission in 2002, in part out of concerns that military psychiatrists even
then were handing out too many pills.
For the Army and the Marines, using the drugs has become a wager that
whatever problems occur will be isolated and containable, said James Culp, a
former Army paratrooper and now a high-profile military defense lawyer. He
recently defended an Army private accused of murder, arguing that his mental
illness was exacerbated by the antidepressant Zoloft.
“What do you do when 30-80% of the people that you have in the military have
gone on three or more deployments, and they are mentally worn out? What do
you do when they can’t sleep? You make a calculated risk in prescribing
these medications,” Culp said.
The potential effect on military personnel has special resonance in the wake
of several high-profile cases, most notably the one involving Staff Sgt.
Robert Bales, accused of murdering 17 civilians in Afghanistan. His
attorneys have asked for a list of all medicines the 38-year-old soldier was
taking.
“We don’t know whether he was or was not on any medicines, which is why [his
attorney] has asked to be provided the list of medications,” said Richard
Adler, a Seattle psychiatrist who is consulting on Bales’ defense.
***
While there was some early, ad hoc use of psychotropic drugs in the Vietnam
War, the modern Army psychiatrist’s deployment kit is likely to include nine
kinds of antidepressants, benzodiazepines for anxiety, four antipsychotics,
two kinds of sleep aids, and drugs for attention-deficit hyperactivity
disorder, according to a 2007 review in the journal Military Medicine.
Some troops in Afghanistan are prescribed mefloquine, an antimalarial drug
that has been increasingly associated with paranoia, thoughts of suicide and
violent anger spells that soldiers describe as “mefloquine rage.”
“Prior to the Iraq war, soldiers could not go into combat on psychiatric
drugs, period. Not very long ago, going back maybe 10 or 12 years, you
couldn’t even go into the armed services if you used any of these drugs, in
particular stimulants,” said Peter Breggin, a New York psychiatrist who has
written widely about psychiatric drugs and violence.
“But they’ve changed that…. I’m getting a new kind of call right now, and
that’s people saying the psychiatrist won’t approve their deployment unless
they take psychiatric drugs.”
Military doctors say most drugs’ safety and efficacy is so well-established
that it would be a mistake to send battalions into combat without the help
of medications that can prevent suicides, help soldiers rest and calm
shattered nerves.
Fueling much of the controversy in recent years, though, are reports of a
possible link between the popular class of antidepressants known as
selective serotonin reuptake inhibitors (SSRIs) < drugs such as Prozac,
Paxil and Zoloft, which boost serotonin levels in the brain < and an
elevated risk of suicide among young people. The drugs carry a warning label
for those up to 24 < the very age of most young military recruits.
Last year, one of Culp’s clients, Army Pfc. David Lawrence, pleaded guilty
at Ft. Carson, Colo., to the murder of a Taliban commander in Afghanistan.
He was sentenced to only 12 1/2 years, later reduced to 10 years, after it
was shown that he suffered from schizophrenic episodes that escalated after
the death of a good friend, an Army chaplain.
Deeply depressed and hearing a voice he would later describe as
“female-sounding and never nice,” Lawrence had reportedly feared he would be
thrown out of the Army if he told anyone he was hearing voices < a classic
symptom of schizophrenia. Instead, he’d merely told doctors he was depressed
and thinking of suicide. He was prescribed Zoloft, for depression, and
trazodone, often used as a sleeping aid.
The voices got worse, and Lawrence began seeing hallucinations of the
chaplain, minus his head. Eventually, Lawrence walked into the Taliban
commander’s jail cell and shot him in the face.
“They give him this, and they send him out with a gun,” said his father,
Brett Lawrence.
Up until the Burke case, there had been few if any recent rulings
exonerating military defendants claiming to be incapacitated by medications.
Burke’s case may have marked a turning point. Four Army doctors concluded
that he wasn’t mentally responsible for his actions < a finding none of them
would have made had he been merely drunk.
“Three drinks over an entire evening is not enough to black somebody out,
but I don’t remember 99% of what happened over the rest of that evening,”
Burke said in an interview. “It was kind of like I was misfiring on the
cylinders.”
***
Both the American Psychological Assn. and the American Psychiatric Assn. in
a 2010 congressional hearing urged the Army to stay the course on
psychotropic drugs.
The real danger, said the psychologists’ spokesman, M. David Rudd, dean of
the college of social and behavioral science at the University of Utah, is
if soldiers are frightened out of access to potentially life-saving
medication.
The Army surgeon general’s office said no one without specific approval is
allowed to go on deployment using psychotropic drugs, including
antidepressants and stimulants, until they’ve been stabilized. Soldiers who
need antipsychotic agents are not allowed to go to combat.
But are those precautions enough? Julie Oligschlaeger said her son, Chad, a
Marine corporal based at Twentynine Palms, came home from his second tour in
Iraq in 2007 complaining of nightmares and hallucinations. He was taking
trazodone, fluoxetine, Seroquel, Lorazepam and propranolol, among other
medications.
“I didn’t realize how many pills he was on until it was too late,” said
Oligschlaeger. “He sometimes would slur his words, and I would think, ‘OK,
are you drinking? What is going on?’ And he’d say, ‘Oh, I’m taking my pills,
and I’m taking them when I’m supposed to.’ I never thought to look.”
In 2008, two months before Chad was scheduled to get out of the Marines,
start college, and marry his fiancee, the young corporal was found dead on
the floor of his room in the barracks. An autopsy concluded the death was
accidental due to multiple-drug toxicity < interactions among too many
drugs.
At the memorial service, Oligschlaeger looked her son’s commander in the eye
and reminded him that Chad had waited in vain for a bed in a combat stress
treatment facility. “I asked him, ‘Why didn’t you have your eyes on your
Marine?’” she said. “He didn’t answer me. He just stood there with his hands
behind his back. And he looked at me.”
By Kim Murphy, Los Angeles Times
