Policies on mentally troubled troops questioned


When Army Sgt. 1st Class Mark C. Warren of La Grande, Ore., received a diagnosis of depression soon after his deployment to Iraq, a military doctor handed him a supply of the mood-altering drug Effexor.

Marine Pfc. Robert Guy, of Willards, Md., was given Zoloft to relieve the depression he had developed in Iraq.

And Army Pfc. Melissa Hobart of East Haven, Conn., took the Celexa she had been prescribed to ease the anxiety of being separated from her young daughter while she was deployed to Baghdad.

Each is among a growing number of mentally troubled service members treated in combat with potent psychotropic medications but with little or no medical monitoring or mental health counseling.

Warren, 44, and Guy, 26, committed suicide last year, according to the military. Hobart, 22, collapsed in June 2004; no cause has been determined.

Interviews with members of the military, their families and medical experts, along with autopsy and investigative reports obtained by The Hartford Courant, reveal that the military's emphasis on retaining psychologically unfit troops has had dangerous, sometimes tragic consequences.

The practice is at odds with the military's medical guidelines, which state that certain mental illnesses and medications are incompatible with deployment to a combat zone.

It also conflicts with statements by top military health officials, who have indicated to Congress that psychiatric drugs are not being used to keep service members with serious disorders in combat.

Military officials say their use of medications is judicious, and they argue that keeping troubled troops close to the front lines is in the service members' best interests because it helps them avoid the stigma of abandoning their duty.

Many outside the chain of command disagree.

"It's best for the Army," said Paul Rieckhoff, a former platoon leader in Iraq who said he was overruled when he tried to have a mentally ill soldier evacuated. "But find me an independent mental health expert who thinks that that's a proper course of action."

Drugs in a class known as SSRIs, such as Zoloft, Prozac, Paxil and Celexa, are the most commonly prescribed antidepressants. They can worsen depression and increase suicidal thinking in depressed patients, and the Food and Drug Administration says patients taking any anti-depressant medication should be monitored carefully when the drugs are first prescribed, a task that can be difficult in a war zone.

Some Iraq war veterans say antidepressants and sleep aids were relatively easy to obtain, with no requirement for regular counseling or follow-up care.

Paul Scaglione, 23, an Army mechanic from the Detroit area, said he was put on Wellbutrin in 2003.

"It was no big deal," he said. "They just talk to you a little and give it to you. They say you can come back if you want, but they don't follow up or anything."

Col. Elspeth Ritchie, psychiatry consultant to the Army surgeon general, said psychiatric drugs were used "judiciously and carefully," and that troops receiving them were afforded a "balance of care," including counseling.

"If you have somebody who's been on the medication and it's safe and effective, you can think of it as similar to a hypertension drug, if somebody needs hypertension medications over in [the combat] theater," she said.

The number of troops taking psychiatric drugs remains a military mystery. In response to a Freedom of Information Act request by The Courant, officials released only limited records on medications prescribed for service members in Iraq.

Those records and Army reports indicate that the availability and use of psychiatric drugs in Iraq has increased steadily.

A 2004 report by a team of Army mental health professionals found widespread complaints from combat doctors about a lack of psychotropic drugs, which prompted the military to approve making antidepressants, including Prozac, Zoloft and trazodone, more widely available. A follow-up report 13 months later noted no such complaints about access to drugs.

Caution issued

In a little-noticed change a year ago, the Army revised its deployment guidelines to include a caution against deploying troops who were taking antidepressants for "moderate to severe" depression.

William Winkenwerder Jr., the assistant secretary of defense for health affairs, reaffirmed that point in testimony to Congress last summer. Winkenwerder, the military's top health official, said the military allowed troops on psychotropic medications to be deployed if they were on a maintenance dose after a condition had been "fully resolved."

How the military interprets "fully resolved" is in question.

"We have seen people diagnosed within three to four weeks [before] deployment, put on medications like Paxil, and their deployment schedule rolls along," said Kathleen Gilberd, a San Diego legal counselor for service members who heads the Military Law Task Force of the National Lawyers Guild.

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