Psychotropic medication use in the Armed Forces: prescription patterns and treatment after trauma

Abstract

What are the trends in the use of psychotropic medication by Dutch soldiers? This is the central question in this thesis in which the characteristics of psychotropic medication use within the Dutch Armed Forces and in a cohort after admission to an intensive care unit are evaluated. The treatment with psychotropic medication of deployment-related trauma in Dutch veterans was also investigated. During duties and in particular exposure to potential traumatic events during deployment, soldiers have an increased risk of developing psychological problems such as post-traumatic stress disorder (PTSD). The treatment of these problems consists of psychotherapy and psychotropic medication use (such as benzodiazepines, antidepressants, antipsychotics, anticonvulsants and psychostimulants). Both the psychological problems and the psychotropic medication used make a soldier less employable. Within the Armed Forces, the use of psychotropic medication has increased sharply over a period of 10 years. It has tripled in soldiers after deployment. Despite this increase, Dutch soldiers used significantly less psychotropic medication than the Dutch general population. It is also striking that antidepressants, which are an important part of the psychotropic medication, are often only used for a short time. This increases the risk of insufficient treatment results and relapse over time. Treating veterans with PTSD is not always easy. Psychotropic medication appears to have a positive, but modest, effect on treatment outcome in veterans with PTSD who are also receiving psychotherapy. Innovative in this is the use of medical cannabis. Veterans with PTSD report important therapeutic effects, including improved sleep quality. However, stigma appears to play an important role in the consideration of starting.