In This Issue: The Military's Billion-Dollar Pill Problem
Credit: Photograph by Peter Bohler

Suffering under the unfathomable strain caused by two extended wars and some of the most intense fighting in our nation's history, the suicide rate among active duty soldiers and veterans is at an all-time high – prompting Secretary of Defense Leon Panetta to dub it "an epidemic." The U.S. military has spent more than a billion dollars on psychiatric drugs as part of the effort to help combat the problem. The most commonly prescribed drugs to treat Post Traumatic Stress Disorder (and also as sleep aids) are anti-depressants and a class of anti-psychotics that includes Seroqel. The tragically ironic issue, however, is that with many of these drugs, some of the possible side effects include suicidal urges. One psychiatrist describes one side effect, the disorder akathisia, as "an agitation so horrifying that it commonly causes people to feel suicidal. It's like being tormented from the inside out."

The article recounts the struggles of several veterans who were prescribed some of the drugs in question, either while fighting in Iraq and Afghanistan or back home by Veterans Administration doctors. Twenty-four-year-old gunner Andrew Trotto was given up to 20 different psychiatric medications, including Seroquel, both at home and overseas. He was on four or five when he locked himself in a Porta-Potty in Iraq with an M16 in his mouth. "They hand that shit out like Skittles," he claims. "You get a bottle for 10 days, and if you run out, they give you more. They had no clue what the hell they were doing. They just throw you on a drug, and if it doesn't work, they throw you on something else."

The result is that American soldiers have never been more medicated than they are today. In 2010, more than 213,000 service members – roughly 20 percent of the active-duty military – were taking medications the military considers "high risk." This includes atypical anti-psychotics like Seroqel, which carry a warning label for suicide and can cost as much as $10 a dose. The use or abuse of such drugs are examples of the controversial practice of prescribing drugs for "off-label use" (whereby a physician treats a patient with a medication approved for use with another condition). As a panel from the Institute of Medicine wrote in a strong criticism of this practice: "If airline travel were like health care, each pilot would be free to design his or her own preflight safety check, or not to perform one at all."