Prescription Stimulants and the Development of Post-Traumatic Stress Disorder among U.S. Service Members

Post-traumatic stress disorder PTSD occurs among both civilians and military personnel after traumatic events, and has become a signature wound of the recent conflicts in Iraq and Afghanistan. The relationship between novel risk factors, such as prescription stimulants, and the subsequent development of PTSD is unknown. We studied 25,971 military members from a large prospective cohort that began enrollment prior to September 11th, 2001. Medication prescriptions were obtained from the military Pharmacy Data Transaction System, and PTSD diagnosis was based on a validated survey instrument PTSD Checklist Civilian Version. The risk of incident PTSD with stimulant use was estimated using survival analyses, while adjusting for sociodemographic factors, military service characteristics, baseline mental and physical health status, deployment experiences e.g., combat, and physicalsexual trauma. Overall, 1376 5.3 persons developed incident PTSD during follow-up. Prescription stimulants were significantly associated with incident PTSD hazard ratio HR, 3.34 95 confidence interval CI, 2.35 4.74 p0.001 in the adjusted model. The magnitude of this association exceeded that of a combat deployment and incident PTSD HR, 1.62 95 CI, 1.42 1.84 p0.001. A dose-related relationship between the days supply and number of stimulant prescriptions with PTSD was noted. The findings suggest that prescription stimulants may increase the risk of subsequent development of PTSD. These data may inform the underlying pathogenesis of and preventive strategies for PTSD.