A new study has highlighted that veterans with PTSD who are treated with multiple medications at once – known as polypharmacy – are at significant risk of adverse health events, including drowsiness and confusion, respiratory depression, and postural instability, which can lead to falls, fractures, hospital admission, illness, and even death.

The research, carried out by Gallipoli Medical Research Foundation (GMRF), aims to raise awareness of the potential for drug-related health implications among veterans and contribute to greater education around improving the treatment of PTSD through medication.

Lead researcher Dr Rebecca Mellor investigated the prevalence of psychotropic polypharmacy in veterans with PTSD who were admitted to a mental health facility, to identify and highlight the potential risks associated with the use of multiple medications to treat veterans with PTSD and other diagnoses.

Psychotropic polypharmacy is the simultaneous use of two or more psychotropic medicines, which are defined as any drug capable of affecting the mind, emotions, and behaviour.

“Psychotropic medications are prescribed for the treatment of PTSD symptoms; however, we’ve illustrated how psychotropic polypharmacy increases the risk of adverse drug events and drug-drug interactions, which can contribute to falls, hospital admissions, morbidity, and mortality,” said Dr Mellor.

“This highlights the importance of increasing awareness of polypharmacy – especially psychotropic polypharmacy – and potentially inappropriate drug combinations, and the need for improved medication review by prescribers.”

Researchers reviewed the medical records of 219 veterans with PTSD who were admitted to a mental health facility over a one-year period, with the findings providing evidence of the extent of the issue of psychotropic polypharmacy in the veteran population with psychological and physical co-diagnoses.

The study found that, in addition to PTSD, 90% of patients had a diagnosis of at least one other psychiatric condition, and 97% had at least one non-psychiatric medical condition. There was a high prevalence of psychotropic polypharmacy (80%), as well as polypharmacy in general (77%) and sedative polypharmacy (75%).

GMRF’s Psychiatric Advisor and Director of Medical Services at Toowong Private Hospital, Dr Andrew Khoo, provided expert guidance on the research. Dr Khoo agrees that polypharmacy is an amendable issue and that optimising prescribing practices would lead to rapid and significant improvements on the morbidity and mortality rates of Australian veterans.

“After 20 years of treating veterans with PTSD, I am aware of how veterans, with their chronic conditions and complex psychiatric and medical comorbidity, typically accrue medications from multiple prescribers over time,” said Dr Khoo.

“This research confirms this impression with real data on Australian veterans treated in a typical setting exhibiting alarming rates of general, psychotropic, and sedative polypharmacy. Given the findings, it is critical that we promulgate this information to both veterans and prescribers.”

This study forms the basis for a longer-term research plan at GMRF, with prescribing guidelines, awareness programs, and educational resources to be developed to support prescribers through the pharmacological management of PTSD and co-morbidities, particularly in veterans. Dr Khoo is also advising on this project.

“This research is an early step in the process of improving pharmacotherapeutic treatment of PTSD and reducing unnecessary overprescribing; we’re hoping to address and change a factor that contributes to morbidity and mortality in PTSD sufferers,” said Dr Mellor.

The research was funded by Ramsay Hospital Research Foundation.

The article ‘Polypharmacy in Australian veterans with post-traumatic stress disorder upon admission to a mental health facility – a retrospective chart review’ was published in the international journal Drugs – Real World Outcomes, on 18 May 2022.