There has been a silent epidemic of deadly drug interactions. If you weren't reading the local news in West Virginia you won't have heard about it. But today they reported the 4th vet to die. These are young men, combat vets taking prescriptions prescribed in combination by Army psychiatrists and they are going to sleep and not waking up. The combination is Klonopin and Seroquel and Paxil. Sometimes pain killers or even alcohol may have been involved.
To date the veterans who have died are Derek Johnson 22 of Hurricane, WV; Andrew White, 23 of Cross Lanes; Eric LAne 29 of Kanawha City and Nicholas Endicott of Logan country. Today's story from the Charleston Gazette-Mail was written by Julie Robinson. She reports:
Stan White, father of soldier Andrew White, has become an advocate for families of returning veterans with post-traumatic stress disorder. During his son's struggle with the disorder and since his death, White has tracked similar cases. He knows of about eight in the tri-state area of Kentucky, Ohio and West Virginia.
He and his wife, Shirley, introduced themselves to the Johnsons and Underwoods at Derek's funeral and offered their help. He is in contact with the office of Sen. Jay Rockefeller, D-W.Va., who is a member of the Veterans' Affairs Committee. Rockefeller requested an investigation into these deaths, which is ongoing, said Steven Broderick, the senator's press secretary.
"When I talked to his family about Derek, I realized it was the same old story," said White. "It was all too familiar. He was taking those same drugs as the others, and, yes, I believe they are still prescribing that combination."
Here are some more links to this story: link
My spouse is a Vet Center team leader and an experienced social science researcher. He is very concerned that this is within the bounds of chance. This means that other people may be experiencing these risks and don't know about it. Our veterans are coming home with PTSD and prescriptions. He doesn't prescribe and is not in charge of patients' medications- he does behavioral therapy. However as a scientist I was concerned about these reports so I decided to look through the literature to see if I could learn more about these drugs and how they work.
CAUTION: All these drugs can cause serious problems if there is any sudden withdrawal. So don't just stop taking them- or tell people to stop taking them. But do have them discuss this with a physician and especially, avoid pain drugs or alcohol with these drugs.
More about these drugs: Klonopin (generically Clonazepam) is used to control seizures and relieve anxiety and nightmares. It causes drowsiness- which can be useful if your PTSD nightmares are keeping you awake. It is a member of a class of drugs called benzodiazepines. They reduce anxiety symptoms rapidly but lead to sedation and are addictive for many. The benzodiazepines are not recommended for people use alcohol- which is something common among persons with PTSD. There can be some bad interactions.
Seroquel (generically Quetiapine) is an antipsychotic prescribed for bipolar disorder and schizophrenia. The use of this drug for PTSD treatment is considered "off-label". However
Recent guidelines suggest that newer (atypical) antipsychotics (aripiprazole [Abilify], olanzapine [Zyprexa], paliperidone [Invega], quetiapine [Seroquel], risperidone [Risperdal] and ziprasidone [Geodon]) are obviously suitable for individuals with psychotic features in their PTSD or certain other psychiatric disorders plus PTSD. These antipsychotic medications may also be helpful for some individuals who have not benefited from medications indicated for PTSD.
link
There have been some clinical trials to support its use in Croatia link
and the USA link
Paxil (generically Paroxetine)is a comonly prescribed antidepressant and it is one of two drugs approved for treating PTSD link. It acts as a selective seratonin reuptake inhibitor. It also causes drowsiness. Serious ventricular arrhythmias and sudden death have been reported as side affects with some other drugs, but not with the other two considered part of this combination.
I checked out these drug combinations in PubMed to see what they reported. One thing I noticed right away is that searching with all three generic names resulted in no hits- indicating no studies on all three together. Searching with just Clonazepam and Paroxetine resulted in 27 hits. Of those, four seemed most relevant. Two papers indicated that this drug combination worked faster at relieving social anxiety disorder but not necessarily better in the long run. link link They did report the drugs are used often in combination but hadn't been tested much as such. For example, the Selective Seratonin Uptake drugs were tested with quetiapine link for PTSD and the combination was reported effective.
So it sounds like individual drugs have been tested and found to have some useful effects. Some of the combinations have been tested and found effective but the combination of all three together hasn't a lot of scholarship. Also, this is a heady mix when combined with the sorts of drugs people take themselves at home as home remedies- alcohol, St. John's Wort, tryptophan or protein supplements. One of the authors for a review on these drug treatments commented:
Combination treatments may be beneficial, but more research is needed.
link
The GI Bill is an important issue, but so is health care that works. If someone who knows Senator Obama (also on the Veterans Committee) could forward this to him and ask for his assistance, I would appreciate it. There are alerts that can go out for drug interactions and it would be helpful nationally if such a search were done of the medical records. Problem is some are in the military records systems which need to be searched separately, while others are in the VA system and still others are getting help from local physicians who may be just renewing prescriptions.