VA still prescribing tranquilizers to veterans with PTSD, despite warnings

Veterans diagnosed with post-traumatic stress disorder (PTSD) are still being prescribed tranquilizers – such as Valium and Xanax – by doctors from the Department of Veterans Affairs, Stars and Stripes reported.

This practice, however, is in direct contrast to VA guidelines, which advise against tranquilizer use for this purpose. According to Dr. Nancy Bernardy, a psychologist for the VA’s National Center for PTSD, the number of veterans being treated by the VA for PTSD has increased three-fold over the past decade, up to around 500,000 patients in 2009.

Bernardy and her colleagues have co-authored a soon-to-be-published study, which analyzed the VA prescription records of veterans with PTSD from 2009 to 2012.

The findings revealed that nearly a third of these veterans with PTSD are being given benzodiazepines – sedatives most often used to treat insomnia, anxiety, seizures and other disorders.  While benzodiazepine prescriptions for veteran PTSD patients have declined from 37 percent to 30 percent up until 2009, prescriptions have remained at 30 percent through 2012.

Current clinical guidelines, co-authored by the VA and Department of Defense, advise physicians against using benzodiazepines, citing a lack of efficacy data and growing concern for risk of harm, Stars and Stripes said.

Benzodiazepines replaced barbiturates in the 1960s as the sedative of choice for PTSD treatment, because it was they were shown to help control anxiety and insomnia.  However, there is a lack of evidence that these sedatives actually treat “core” symptoms of PTSD – such as avoidance, hyperarousal, numbing and dissociation, and many feel that the drugs actually hinder other effective PTSD treatments.

The DOD/VA guidelines also caution against prescribing benzodiazepines to veterans with substance abuse problems or mild traumatic brain injuries

“Once initiated, benzodiazepines can be very difficult, if not impossible, to discontinue due to significant withdrawal symptoms compounded by the underlying PTSD symptoms,” the VA/DOD guidelines state.

Most of the benzodiazepines being prescribed for PTSD veterans are coming from mental health providers – not primary care physicians, Stars and Stripes reported.  Bernardy and researchers hope to do more researcher to determine whether the discrepancy has to do with ignorance of VA guidelines.

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