20 suicides a day

Gutted: Polypharmacy and the epidemic of suicide among post-9/11 veterans: Part 2

20 suicides a day

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By Patrick D Hahn 

On 3 August of this year the US Department of Veterans Affairs released its long-awaited report, Suicide Among Veterans and Other Americans 2001-2014. This report was the most comprehensive analysis of veteran suicide in our nation’s history, examining more than 55 million veteran records from 1979 through 2014, from all 50 states as well as four territories.

Compared to that of the general population, the suicide rate for veterans has risen steadily. Prior to 2006, the suicide rate for veterans, adjusted for age and sex, was actually lower than that of non-veterans. By 2014, the adjusted suicide rate for veterans was 21% higher, which in absolute terms works out to approximately 20 suicides a day.

But the most shocking finding can be found in Table 5 of the report, which shows suicide rates for veterans of Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn. Suicide rates for VHA users who were veterans of these operations more than doubled between 2003 and 2014. For the age group 18-24, the increase in suicide was a staggering 400%.

Gutted: Polypharmacy and the epidemic of suicide among post-9/11 veterans:
Part 1: • Feasting on the dead
Part 2: • 20 suicides a day

The VHA has stepped up efforts to help suicidal veterans. But is all this help really helping?

Table 1 of the report shows suicide rates for users of VHA services. The suicide rate for those who receive mental health treatment is higher than those who do not. No big surprise there: presumably those who received mental health treatment were more impaired to begin with than those who did not.

The real surprise comes when we compare VHA users who had no diagnosis of mental health or substance abuse issues (and presumably were less impaired) with VHA users who had a diagnosis (and presumably were more impaired). The less impaired users who got mental health treatment had a suicide rate 38% higher than the more impaired users who did not. These data call into question the effectiveness of VHA programs for assisting suicidal veterans.

What is going wrong? A 2009 paper by Marcia Valenstein of the Department of Veterans Affairs Medical Center in Ann Arbor gives us a clue. Dr. Valenstein and her colleagues looked at all veterans treated by the VHA for depression between 1 April 1999 and 30 September 2004—887,859 patients in all. They found that the rate of completed suicides doubled in the three-month period following new antidepressant starts.

With proper scientific caution, the authors noted that these results are not proof of a cause-and-effect relationship: “The increase in completed suicide observed in clinical settings may be due in part to antidepressant exposure, but also reflects patients’ illness severity.” But there is overwhelming evidence that antidepressants cause violence and suicidality in some of the patients who take them, especially in young people. This evidence began coming in almost as soon as these drugs were placed on the market and continues to accumulate to this day, being confirmed most recently by a meta-analysis of 70 randomized clinical trials released earlier this year by the Nordic Cochrane Collaboration, the most comprehensive study of its kind to date, which found that antidepressants more than doubled the rate of aggression and suicidality in children and adolescents under the age of 18.

Peter Breggin is a psychiatrist of 48 years experience and the author of Psychiatric Drug Withdrawal. On 24 February 2010 he testified before the US House of Representatives Committee on Veteran’s Affairs. After noting that antidepressants double the rate of suicidality in young people in clinical trials, he argued that there is every reason to believe that the increase in actual clinical practice should be even greater. In clinical trials, he noted, “the patient is monitored every week by experts, and informed of all the dangers presumably, and the patient is given huge hope. You are in this wonderful research setting where you are getting something new and wonderful.

“Now, when you get a doubling of suicide attempts and ideation under those conditions, you can assume that in the military or clinical practice it is going to be multiples, unknown multiples because there it is given for months, there it is not monitored, there psychotic patients are not excluded, there suicidal patients are not excluded, and all of that is excluded from the clinical trials.”

He went on to note that the DSM-IV warns that mania is a known toxic effect of antidepressants, and added “Mania is an out-of-control state that increases vastly the risk of violence and suicide… Imagine causing that in young men and women who are heavily armed and under a great deal of distress. And irritability, hostility, aggressiveness, impulsivity not only lead to violence but to suicide.”

The risk increases when doctors start combining these drugs. A 2016 paper by Garen Collett of the South Texas Veterans Healthcare System looked at veterans of the conflicts in Iraq and Afghanistan who used VHA services during the fiscal year 2011—a total of 311,400 patients in all. The authors found that 8.4% of Iraq and Afghanistan veterans, or 25,546 in all, were subjected to polypharmacy, which the authors defined as taking five or more psychotropic medications concurrently. After controlling for age, sex, race/ethnicity, co-morbid conditions, prior overdose events, and prior suicide-related behaviors, the authors found that polypharmacy almost quadrupled the risk of overdose and suicide-related behaviors.

In a telephone interview, Dr. Breggin declared “Psychiatric drugs are among the most potent neurotoxins in the world. When you take a psychiatric drug, you pollute your brain with an intensity that your brain will never experience throughout its life from any other source. Once you begin causing that level of poisoning of the brain, individuals will go into a decline. When you put one toxin upon another upon another, you’re going to get all kinds of untoward effects. One of them is going to be suicide, another is going to violence, another is going to be multiple physical illnesses, another is going to be shortened lifespan. Anything we’re going to be able to measure in terms of quality of life and health in general is going to be harmed by what we’re doing to our veterans with these multiple neurotoxic assaults on the brain.”

In regard to what was done to David Cope, Dr. Breggin strongly criticized the practice of stopping Ativan and Adderall without any tapering period. “Benzodiazepines and stimulants are classically addictive drugs. No physician should be abruptly stopping benzodiazepines or other sedatives or any stimulant drugs.”

I asked Dr. Breggin if he knew of any changes have been made since he testified at the congressional hearing on veteran suicide in 2010. “I don’t think there’s been any substantial changes for the better,” he told me. “The drug companies have billions of dollars that they spend promoting their drugs and silencing their critics.”

He went on to explain, “The kinds of issues that people deal with that result in their getting psychiatric drugs are not helped by psychiatric drugs, which can only harm the brain and make it more difficult to feel your feelings and to think clearly. The drugs interfere with normal feelings. They drug the veterans, hoping basically to stupefy them and make them passive so they won’t demand services.

“I think it’s a crime that those who are veterans, who have survived our wars, are being killed off by the pharmaceutical empire and its practices. Soldiers who have come back with post-traumatic stress disorder are rendered unable to recover by the current use of neurotoxins as treatments.”

And what about David Cope and William, the two disabled naval veterans we met in Part One? Two young lives of almost limitless potential, now in ruins. One had PTSD, the other did not. The common thread here is not PTSD—the common thread is psychiatric drugs, taken in combinations that have never been tested, far beyond the duration of most clinical trials.

“The VHA is there to get us all in the grave as fast as possible,” William says. He has given up on the VHA, although he still in under the care of a civilian psychiatrist. Today he is being maintained on a cocktail of zonisamide, prazosin, quetiapine, cyclobenzaprine, gabapentin, hydrocodone, amlodipine, and Januvia. He remains bitter about his experiences with the government doctors. “Instead of saying, ‘Have a shoebox full of medications,’ there should be a higher accountability,” he tells me.

David Cope agrees. “There’s a wholesale failure to recognize the potential for adverse effects from the drugs,” he tells me. “The other thing that’s shocking to me is there is known adverse effects from the individual drugs, but there’s no reluctance on their part to start combining drugs from different classes, just to see what happens. It’s a kind of Russian roulette.”

The after-effects of this game of Russian roulette are with David to this day. “I used to be able to empathize with people.” he laments. “That doesn’t exist in me any more. I don’t have it. I’ve been wiped out. I’ve been totally gutted—intellectually, emotionally, physically gutted and left hung out to dry.”

List of Sources

• US Department of Veterans Affairs 2016. Suicide Among Veterans and Other Americans 2001-2014.
• Valenstein, M. et al. 2009. Higher risk for suicide among VA patients receiving depression treatment. Journal of Affective Disorders 112:50-58.
• Sharma, T. et al. 2016. Suicidality and aggression during antidepressant treatment: systematic review and meta-analyses based on clinical study reports. BMJ 2016; 352 http://dx.doi.org/10.1136/bmj.i65” rel=“nofollow”>doi
• House Committee on Veterans Affairs 2010. Exploring the Relationship Between Medication and Veteran Suicide.
• Collett, G. et al. 2016. Prevalence of central nervous system polypharmacy and associations with overdose and suicide-related behaviors in Iraq and Afghanistan war veterans in VA care 2010-2011. Drugs—Real World Outcomes 3:45-52.