Improving Care for Veterans with PTSD: Comparing Risks and Benefits of Antipsychotics versus Other Medications to Augment First-Line Pharmacologic Therapy
Technical Report,30 Sep 2017,29 Sep 2018
Northern California Institute for Research and Education Inc. San Francisco United States
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The goal of this project is to use national Veterans Affairs VA healthcare data to determine the benefits and risks of use of antipsychotic medications to augment first-line medication therapy in patients with posttraumatic stress disorder PTSD. To date, over 2.5 million American men and women have served in support of the military operations in Iraq and Afghanistan. PTSD is the most commonly diagnosed mental health disorder in Veterans, with nearly 1 in 3 returning Iraq and Afghanistan Veterans seen in VA care receiving this diagnosis. In addition to counseling therapies, several medications are effective intreating PTSD symptoms. However, clinical trials show less than 30 of patients will achieve remission of PTSD symptoms with these treatments. Therefore, providers and patients will look for additional medications to augment therapy. Antipsychotic medications are FDA-approved and beneficial for the treatment of bipolar disorder and psychotic disorders, such as schizophrenia. However, they have been increasingly prescribed off-label for non-approved conditions, such as PTSD. In a prior study, we found that 1 in 5 returning Iraq and Afghanistan Veterans with PTSD seen in VA care were receiving an antipsychotic medication in the absence of one of the approved conditions. This is occurring despite VA and DoD guidelines that discourage the use of antipsychotics for PTSD treatment because there is still considerable debate about whether antipsychotic medications are safe and effective in PTSD. This project uses the VA healthcare data of Veterans with PTSD to compare the effects of antipsychotics versus other types of psychiatric medications to determine metabolic and mental health outcomes, as well as gender and racial differences in the risks and benefits of antipsychotic use.