Dr. Robert Rosenheck, who has worked extensively within the Department of Veterans Affairs, describes off-label use in the VA as "quite high." "The rules around truth-in-marketing have allowed drug companies to publish scientific articles saying various things," he says. "They can hand out articles that encourage doctors to believe things the FDA does not approve."
The DOD could fix the problem by banning off-label prescribing, but it won't. "Off-label use of psychotropic medications is common, legal, and within the standard of care," says Capt. Michael Colston, M.D., in an email. The Institute of Medicine, a branch of the National Academy of Sciences, which advises the federal government, sees it differently. "If airline travel were like health care," its panel wrote, "each pilot would be free to design his or her own preflight safety check, or not to perform one at all."
Andrew Trotto is now off every one of the drugs he was once prescribed by military and VA doctors. He went off the pills in 2011, with the help of cannabis and an aid dog, and is even planning on going back to school. He hit the gym and lost the 40 pounds he'd gained, but he can't lose the other effects of war: the ringing in his ears, the traumatic brain and back injuries. But, he says, "I can wake up in the morning and not be a total zombie. There are no more suicidal or homicidal ideations. I still have my problems with PTSD – anger issues, nightmares, and flashbacks. But I am able to deal with them and control them a lot better than I could while on the medication." His time in uniform and its aftermath have left him bitter about the military and the drug industry. "I do everything holistic now. I calm myself by sitting in the sauna. I will not go to a doctor and take the pills."