The increase in medications was parallel with an increase in the number of the military's "waivers" (a military-recruiting term describing a recruit who has committed acts that under previous conditions would have disqualified him from military service, including marijuana possession and DUI, misdemeanors, and felonies). Waivers jumped from nearly five percent in 2004 to 11 percent leading up to the surge, and the number of Army recruits who graduated high school fell from 91 percent in 2001 to 79 percent this past year. The Armed Forces Health Surveillance Center's May report did not even include sleep medications, such as Ambien and Lunesta, and antidepressants used to stop smoking, such as Wellbutrin, but did include common SSRIs (Paxil, Zoloft, and Prozac), anti-anxiety medications (Valium, Ativan, and Xanax), attention-deficit medication (Ritalin, Adderall), and antipsychotics (Seroquel).
Concurrently, distribution of medications by military mental-health personnel has increased, especially in post-surge Iraq. Despite increases in medications and in troops — and certainly in troops suffering from PTSD — the number of Army mental-health personnel on the ground in Iraq has remained disturbingly the same: 215.
According to the Army Mental-Health Advisory Team's survey of military medical personnel included in its mental-health report this past February, those in Iraq treating soldiers with mental-health issues say they prescribe depression, sleep-deprivation, and anti-anxiety medications 64, 52, and 60 percent of the time, respectively, a significant increase compared with the 45, 30, and 42 percent of the time a year earlier. Doctors say side effects — including depression and manic episodes — are being ignored.
"If someone has not had a thorough diagnosis — and there's really not time for that on the front lines a lot of the time — and a doc on the front lines is thinking, 'This isn't an acute-stress reaction, this is just someone who was shaken up,' [he may] give them an SSRI, [which] can induce a manic episode in some people," says Dr. Chad S. Peterson, former medical director of the San Francisco VA Medical Center's PTSD clinical team and its primary contact for returning Iraq and Afghanistan veterans. "If the follow-up isn't good and you get a soldier who becomes manic, then manic people are notoriously not good judges of behavior. Their judgment is poor — and that could really be a problem with someone carrying a weapon."
The rise in use of such medications is the symptom of a much larger concern. Nearly 40 percent of military doctors in Iraq say they helped a service member with a mental-health problem on a weekly basis this past year, as opposed to 25 percent a year earlier, according to the Army's mental-health report. Also, 26 percent referred patients to mental-health care this past year, as opposed to 15 percent a year earlier.
Concerns about the use of drugs deemed "clinically and operationally problematic" on the battlefield led to the passage, in October 2006, of a federal law that required the military to state which conditions and ensuing use of psychotropic drugs would "preclude deployment" — that is, keep a soldier from being sent to a war zone. The office of the secretary of defense (at that time, Donald Rumsfeld) responded that only psychotic and bipolar disorders could prevent someone from serving, and that using medications for other mental-health conditions — such as PTSD — is "compatible with deployment."