In February 2009, Americans heard about a dramatic rise in suicides among U.S. soldiers. While treatment for emotionally troubled soldiers increasingly consists of antidepressants such as Prozac, Paxil, and Zoloft, recent investigations show that these drugs are no more effective than placebos and can actually increase suicidality. In order to prevent even more suicides, both the research and basic common sense instruct us that we need less psychiatric drugs and more political courage.
Suicides in the U.S. Army rose for the fourth straight year in 2008. Army statistics, which include the Army Reserve and the National Guard, confirm 128 suicides (with 15 more deaths under investigation). Suicides for the Marines also have increased, with 41 in 2008, up from 33 in 2007 and 25 in 2006.
The number of soldiers who committed suicide during January 2009 actually surpassed the number of soldiers who were killed in combat in Iraq and Afghanistan during that same time period. In January 2009, there were 16 U.S. combat deaths and, the Army believes, 24 suicides (the Army has confirmed 7 suicides and it believes that investigators will confirm an additional 17 other deaths as suicides). January 2009 suicide totals were more than five times higher than January 2008 totals.
Why are so many U.S. soldiers killing themselves? According to Colonel Kathy Platoni, chief clinical psychologist for the Army Reserve and National Guard, one major reason is multiple deployments. Army psychiatrist Colonel Charles Hoge reports that by early 2008, nearly 30 percent of troops were on their third deployment. Another reason appears to be more psychiatric drug use.
Increasing Antidepressant Use
For many mental health professionals, especially governmental ones, a "good treatment outcome" consists of a troubled person adapting to a miserable, dehumanizing environment in a way that causes the least problems for authorities. Too few mental health professionals tell authorities that the best "treatment" sometimes means helping a troubled person to exit from a miserable environment. Whether it is a troubled soldier in a horrifying war zone or a disruptive child in a boring school, mental health professionals are far less likely to recommend a radical altering of an environment than they are to recommend a chemical altering of the person suffering in it.
An increasing number of U.S. combat troops are taking daily doses of antidepressants to "take the edge off" and calm nerves. According to the U.S. Army, based on an anonymous survey of troops taken in the fall of 2007, about 12 percent of combat troops in Iraq and 17 percent of those in Afghanistan were taking antidepressants or sleeping pills. Those percentages have likely increased, and Colonel Platoni noted that the excessive use of antidepressants for troubled soldiers may be another reason why so many of them are killing themselves.
How can a drug that is called an "antidepressant" result in more suicidal soldiers? According to the Food and Drug Administration (FDA) "black box" warnings on Prozac and other so-called antidepressants, "Antidepressants increase the risk compared to placebo of suicidal thinking and behavior in children, adolescents, and young adults."
Grace Jackson, former staff psychiatrist at Bethesda Naval Hospital and author of Rethinking Psychiatric Drugs, is an outspoken critic of psychiatric drugs. Jackson states, "New reports about record-breaking numbers of Army suicides are alarming but not surprising." Jackson notes that there are several studies on military personnel, veterans, and the general public that show the suicidal effects of antidepressants.
One study, Jackson points out, is a 2007 investigation reported in the American Journal of Psychiatry ("Relationship Between Antidepressants and Suicide Attempts: An Analysis of the Veterans Health Administration Data Sets"), which examined veterans who received treatment for depression in either 2003 or 2004. Study findings were that antidepressant treatment was associated with a higher rate of suicide attempts relative to those who were not treated with drugs.
Especially damning for antidepressants is a 2009 Journal of Affective Disorders study ("Psychopharmacological Treatment Before Suicide Attempts Among Patients Admitted to a Psychiatric Intensive Care Unit"). Investigators reported that patients who had attempted suicide were more likely to have received antidepressants (as well as benzodiazepines such as Xanax) than patients who did not attempt suicide, and this finding was not biased by differences between the groups in baseline severity of symptoms. Researchers concluded, "The results of this study suggest that the use of antidepressants in patients with mood disorders is not associated with a reduction of suicide attempt rate. Furthermore, from the present study, it is not possible to exclude that antidepressants or benzodiazepines may induce, worsen, or precipitate suicidal behaviors in some patients."
Can We Trust NIMH Studies?
U.S. government officials would like Americans to feel assured that the government is scientifically ascertaining the reasons why soldiers are increasingly killing themselves as well as how to prevent this. In November 2008, the National Institute of Mental Health (NIMH) announced that it and the Army had entered into an agreement to conduct a $50 million study on suicide and suicidal behavior among soldiers.
Do we really need to give $50 million to NIMH psychiatrists and psychologists to discover that when one has been in, or is currently in, or is about to be deployed to a miserable, terrifying, traumatizing place, it is likely that one will feel suicidal? More importantly, should we trust the NIMH when it comes to treatment recommendations?
One disturbing example of NIMH scientific bankruptcy, and its corruption by drug companies, is the 2006 NIMH-funded Sequential Treatment Alternatives to Relieve Depression (STAR*D). This has become the most quoted study by antidepressant advocates. STAR*D researchers received consulting and speaker fees from the pharmaceutical companies that manufacture the antidepressants studied, but NIMH did not report these conflicts of interest to the general public.
In STAR*D, paid for by U.S. taxpayers at the cost of $35 million, NIMH-funded researchers did not include a placebo control—an essential component of treatment effectiveness research. Yet, to the exasperation of legitimate scientists, NIMH claimed that STAR*D showed that antidepressants are highly effective. NIMH neglected to report that at each treatment step of STAR*D, remission occurred at lower than or equal to the customary placebo performance (routinely around 30 percent in other antidepressant studies that included placebo controls).
After the completion of the first two steps of STAR*D in March 2006, NIMH triumphantly announced a cumulative remission rate of 50 percent. But NIMH did not tell the press that in the same time it took to complete steps one and two of STAR*D—slightly over six months—previous research had shown that depressed people receiving no treatment at all have a spontaneous remission rate of 50 percent.
STAR*D researchers then offered a third and fourth treatment for patients who failed prior ones, but for each of these steps, remission rates plummeted to below 14 percent. This was reported, but it was not stated that this was far lower than customary placebo results.
Upon STAR*D’s completion, in November 2006, STAR*D researchers again exasperated many scientists by failing to incorporate into their overall results both the high relapse rate (for patients who at previous steps were considered to have been successfully treated) and the high treatment dropout rate. NIMH claimed a 70 percent success rate, but independent scientists (who took into account STAR*D’s extremely high relapse and dropout rates) estimated that the actual cumulative remission rate of the four treatment steps was no higher, and probably lower, than 43 percent.
With respect to the current $50 million U.S. Army-NIMH study, can we really trust that it won’t be another sham? I certainly wouldn’t hold my breath waiting for a U.S. Army-NIMH study to include this obvious recommendation: the best mental health treatment to prevent suicide in our soldiers is getting them the hell out of a war zone, especially if the vast majority of Americans believe that the war is unnecessary.
Bruce E. Levine, PhD, is a clinical psychologist and author of Surviving America’s Depression Epidemic: How to Find Morale, Energy, and Community in a World Gone Crazy (Chelsea Green Publishing, 2007).