The Military's Billion-Dollar Pill Problem

Before his military doctors were through with him, Spc. Andrew Trotto, a 24-year-old Army gunner, would be on as many as 20 psychiatric medications. It started in 2008 while he was in Iraq, fighting in Sadr City, at first with difficulty falling asleep, a common problem among soldiers in a combat zone, particularly those, like Trotto, suffering from post-traumatic stress disorder. "For sleep, the first drug they like to go to in Iraq is Seroquel," says Trotto, of the atypical antipsychotic originally developed to treat schizophrenia and bipolar disorder. "They hand that shit out like Skittles. You get a bottle for 10 days, and if you run out, they give you more." His body adapted to the pill over time, and he was soon taking a dose meant for actual psychotics. "They had no clue what the hell they were doing," Trotto says of the doctors at the battalion aid station who prescribed the pills. "They just throw you on a drug, and if it doesn't work, they throw you on something else. 'Try this. Try this. Try this.'"

Though he continued to function in day-to-day combat – nighttime missions clearing houses – his brain was polluted with pharmaceuticals. In addition to Seroquel, he was taking Zoloft for anxiety and Vicodin to relieve pain from ruptured disks he sustained falling nine feet off a tank – and he was still being thrown into combat. "Let me remind you," he says, "I was a gunner, completely whacked out of my mind.There were quite a few of us on Seroquel and antidepressants."

Eventually, he says, he began losing it. Looking back, he's certain it was the drugs that pushed him over the edge. He started seeing things and hearing voices. While in a warrior-recovery unit in Kuwait, he tried to overdose on the Seroquel but only lay in a stupor for two days undisturbed. One day he locked himself in a Porta-Potty with a loaded M16 in his mouth, but he managed to hold out long enough to seek help. "I told them, 'You need to do something, or I am going to take other people out with me.'"

He was sent home to a warrior-transition unit in Colorado, but a year later, he tried to OD in his bathtub. Trotto's father says the sergeant who escorted his son back to Colorado had told him "that he watched Andrew go downhill the minute they put him on Seroquel."

Specialist Trotto's deterioration should not have been surprising to anyone who has read Seroquel's black-box danger label, a warning about the drug's potential to cause suicidal tendencies in some patients. But Seroquel was only one of several drugs that Trotto was given, both in Iraq and in a Veterans Affairs facility at home, that carry such warnings. Still, despite an unprecedented suicide rate among American servicemen and women – a problem so widespread that Secretary of Defense Leon Panetta has called it an epidemic – these same drugs are among the most frequently prescribed medications by the U.S. military and the VA.

American soldiers (active soldiers as well as retired) have never been more medicated than they are now: In 2010, more than 213,000 service members (roughly 20 percent of active-duty military) were taking medications the military considered "high risk" – from epilepsy drugs to psychiatric pills like Seroquel. But what's more incredible is that Seroquel and other antipsychotics are expensive (as much as $10 a dose) and not proven to be effective in treating the very conditions for which the military and VA most often prescribe them: insomnia and PTSD. But that didn't prevent their use by the military from increasing tenfold between 2002 and 2009.

The spike in prescriptions, as well as the growing chorus of concern within the military, prompted a high-level memo from Gen. Jonathan Woodson, M.D., assistant secretary of defense for health affairs, cautioning military personnel about the use of atypical antipsychotics, specifically Seroquel. "Providers should use caution," he wrote in February 2012, "when these agents are used as sleep aids in service members struggling with substance-use disorders.... Providers should offer service members the lowest risk medication and non-medication therapy options for their symptoms."

But for the many thousands of soldiers who'd already struggled to serve their country in a Seroquel-induced fog, it was too late.