Coming home after serving a nine month tour in Iraq, Andrew White was finally home unfortunately he was burdened with symptoms of post traumatic stress disorder such as insomnia, nightmares and continual restlessness. Physicians did attempt to alleviate his symptoms by the use of three psychiatric medications which had included a strong ant-psychotic medication called Seroquel.
There are thousands of soldiers who endure PTSD and have the same medication prescribed in the last nine years, this aided in establishing Seroquel one of the Veteran’s Affairs Departments top medication expense and placed it in the number five positions of best selling medication in the nation.
During the use of this medication, many soldiers and veterans have died. This is creating worries within some military families that the government is not giving the whole picture about the risks associated with this medication. They desire that congress investigate this matter.
In the matter of White, the nightmares had continued. So physicians had advocated increasingly higher doses of the medication Seroquel. White, a twenty- three year old marine corporal at one time he had been prescribed greater than 1,600 milligrams each day which was higher than double the maximum dosage allowed for this medication suggested for schizophrenia patients.
A little while later White had passed on in his sleep.
According to his father Stan White, retired high school principal his son was told that if he had problems sleeping he could take another pill.
The Veteran’s Affairs Department had conducted an investigation their final determination White had died from a rare drug interaction. White was also taking anti-depressant and anti-anxiety pills along with the pain killer which there was no prescription for. Investigators of the case had established that White had received standard care for his particular condition.
There is uncertainty around the fact of how many soldiers have died using Seroquel or if this medication was the direct source of death. Whites death has validated that a minimum of six deaths among soldiers who took Seroquel and White believes there can be others as well.
The government’s military medical systems’ expenditure has risen greater than seven times as much since the beginning of the war in Afghanistan 2001, this is according to documents which were obtained by The Associated Press under the Freedom of Information Act. That greatly exceeds the increase of personnel who have went through the system at that time.
The medication Seroquel is authorized in the treatment of schizophrenia, bipolar disorders and depression however, the Food and Drug Administration has not authorized this medication to be used as a treatment for insomnia. Nevertheless, psychiatrists do have authorization to prescribe approved medications for other uses in usual practice this being referred to as “off-label” prescribing.
However, this medications side effects include diabetes, weight gain, headaches, dry mouth, abnormal muscle movements and rapid weight gain. Whites weight had increased by forty pounds and had experienced slurred speech, disorientation and tremors which are all side effects of this medication.
Vanderbilt University researchers last year had published a study advocating a new risk to this medication being sudden heart failure.
New England Journal of Medicine 2009 edition, contained a study which had shown that there were three cardiac deaths each year for every 1,000 patients who are using anti-psychotic medications such as Seroquel. Seroquel contains a rare sedative reaction which separates it from other medications in its class as the number one choice for the treatment of insomnia and anxiety.
The drugs manufacturer AstraZeneca PLC stated it is reviewing the study.
The Veterans Affairs Department states that Seroquel is only being prescribed as the third or fourth option for patients who have hard to treat insomnia coming from PSTD.
Also receiving treatment for PSTD was Marine Corporal Chad Oligschlaeger who was 21 years old when he had died in his sleep at Camp Pendleton in California, May 2008. The corporal was on six different medications which included Seroquel, in order to cope with anxiety and nightmares which came after two tours of duty in Iraq.
In the case of Oligschlaeger the military medical examiner associated the death to “multiple drug toxicity” signifying that Oligschlaeger had also died from a medication interaction. Due to the complicated reactions between numerous medications medical examiners do not signify these deaths to anyone particular medication.
After conferring with physicians, Oligschlaeger parents Eric and Julie, of Austin, Texas, do believe that their son had died from sudden cardiac arrest caused by the medication Seroquel.
Julie Oligschlaeger had stated currently she is immensely angry and believes someone needs to be held accountable. The rules of this medication without question need to be changed.
Dr. Michael Kilpatrick, The Defense Department’s Deputy Director for force health protection has stated that the government has not witnessed an additional rates of dangerous side effects from Seroquel or other medications.
Physicians that were interviewed by AP they had begun prescribing Seroquel due to the fact it is the only medication available that provides relief from nightmares and anxiety of PSTD.
Dr. Henry Nasrallah, of the University of Cincinnati, for greater than 25 years has treated patients with PSTD, had stated that by accident some person were giving patients Seroquel for anxiety or depression.
Veterans have been noted as saying it was the first time they had slept for six or seven hours straight all night long, they had requested more. Dr. Nasrallah said that had spread the word.
A lot of soldiers and veterans who seek treatment for PSTD go to hospitals in which are operated by the VA or Defense Department.
The Veterans Administrations expenditures have gone up by greater than 770 percent since 2001. Within that same time period the number of patients covered by the VA has gone up by 34 percent.
The VA’s second biggest prescription drug cost since 2007 has been the medication Seroquel it comes right behind the blood thinning medication Plavix. This last fiscal year the VA had spent $125.4 million dollars on Seroquel which is an increase of $14.4 million in 2001.
Expenditures on Seroquel medication, has gone up by almost 700 percent since 2001, to a total of $8.6 million last year, per their purchase records.
Dr. Nasrallah and others have stated they do use medications such as Seroquel off-label due to the fact there are little approved treatments available for PSTD. The FDA has only approved two medications for the condition which are the antidepressants Paxil and Zoloft and they do not always work.
There is only one study which has been published concerning the use of Seroquel for PTSD associated insomnia which consisted of twenty patients that were followed for six weeks at the VA Medical Center located in South Carolina. The study had found moderate improved sleep. This study was funded by the manufactures of Seroquel at the request of Dr. Mark Hammer a VA psychiatrist, who has studied the use of Seroquel for PSTD.
Contained within Dr. Hammer written closings which were published in 2003, he did very strongly suggest vigilance in interpretation of the findings due to the study being small and of short time length.
Currently Dr. Hammer is working on a much larger federally funded studies of Seroquel. Currently he notes that there is little published research on the medication for use in PSTD.
Dr. Hammer remarks that clinical judgment is the best available currently due to the fact there are not any good database to assist decision making. Dr. Hammer works at the Ralph H. Johnson Medical Center in Charleston, South Carolina.
Dr. Hammer had emphasized that the VA guidelines order physicians to observe patients for dangerous side effects as in medication such as Seroquel.
Seroquel was authorized in 1997. It is the second best selling medication for AstraZeneca in the United States. Which had produced sales in the amount of $4.2 billion dollars last year. However, their success has now been damaged by accusations that the company had illegally marketed the medication and downplayed the risks involved. The company has agreed to pay out $520 million dollars in April in order to settle federal accusations that its sales staff endorsed Seroquel for many off-label uses among them insomnia.
Pharmaceutical companies are not allowed to market drugs for unauthorized uses. AstraZeneca is also facing estimates of 10,000 product liability lawsuits, most are from allegations that Seroquel had caused diabetes.
Since the time of his death Corporal White’s family has been in search for an explanation in the hopes of halting other deaths from occurring.
Corporal White’s father had concluded stating that they had trusted the knowledge of physicians and that they would cause no harm. They also put their faith in drug companies because they give research to physicians. The families battle now is in their efforts to get changes made.
There are several alternative treatments available to help with PSTD, these are usually used in conjunction with medications. However, there are cases where they have provided enough relief for persons on their own. Below are a few.
A small study had found that acupuncture can possibly aide persons with PSTD. It showed results in reducing anxiety and aided in sleep benefits.
Chiropractic treatments have been helpful in cases of PSTD, such as the use of CranioSacral therapy.
It is used to treat conditions such as back and neck pain, migraines, stress and fibromyalgia. This therapy basically alleviates the nerve passages so the movement of cerebrospinal fluid moving through the spinal cord is heightened. It has been useful for the symptoms associated with PSTD such as insomnia, heightened awareness, concentration and in some cases has alleviated flashbacks.
Exercise has been known to reduce the stress and anxiety symptoms of persons who are suffering PSTD. Yoga and Tia Chi are two which help promote reduction in anxiety and stress and provides a much better sleep quality at night time.Sources:
New York Times