Back to Top Skip to main content

Military providers seek tailored approach to treating PTSD

The VA/DoD clinical practice guideline for managing post-traumatic stress disorder and acute stress disorder recommends against prescribing benzodiazepines. (U.S. Air Force photo by Airman 1st Class Joseph Pick) The VA/DoD clinical practice guideline for managing post-traumatic stress disorder and acute stress disorder recommends against prescribing benzodiazepines. (U.S. Air Force photo by Airman 1st Class Joseph Pick)

Recommended Content:

Mental Health Care | Military Hospitals and Clinics | Posttraumatic Stress Disorder

FALLS CHURCH, VA — A new reporting tool developed by the Defense Health Agency’s Pharmacy Operations Division is helping ensure Military Health System providers follow best practices in prescribing medications for patients diagnosed with post-traumatic stress disorder.

The PTS Provider Prescribing Profile lists all providers at military treatment facilities who are treating patients with PTSD or acute stress disorder, said Sushma Roberts, Ph.D., a clinical psychologist and senior program manager for DoD/VA Integrated Behavioral Health, Clinical Communities Support Section, Clinical Support Division. The tool also documents the medications providers are prescribing. 

According to the Psychological Health Center of Excellence, PTSD is a medically diagnosed mental health condition that may develop after experiencing, witnessing, or learning the details of a traumatic event such as combat, a natural disaster, sexual assault, or a terrorist attack. 

From February 2000 to February 2018, about 223,000 active-duty service members were diagnosed with PTSD, Roberts said, adding that 75 percent were diagnosed following a deployment of 30 days or longer. 

Currently, the focus is on benzodiazepines, or benzos. The clinical practice guideline released in 2017 recommended against prescribing benzos for PTSD patients, she noted. 

Benzos, also known as tranquilizers, act on the brain and central nervous system to produce a calming effect. People can easily develop a tolerance to benzos, health care experts say, needing higher doses and increased frequency to achieve the same effects. People also may suffer withdrawal symptoms, including insomnia, irritability, anxiety, panic attacks, and seizures.

It’s dangerous to combine benzos with alcohol or other medications such as opioids. In 2015, 23 percent of people who died of an opioid overdose also tested positive for benzo use, according to the Centers for Disease Control and Prevention. 

“Benzos aren’t necessarily bad,” said Army Lt. Col. Dennis Sarmiento, a psychiatrist and chair of the DHA’s Behavioral Health Clinical Community. “There are indications for their use. Short-term, they can help with anxiety, panic, and sleep. Treating such symptoms can help providers engage patients in care and better establish or reinforce rapport.”

Studies have shown a large percentage of service members and veterans who may benefit from treatment for PTSD may not seek care or complete treatment, Sarmiento said.

But medications other than benzos are recommended for treating PTSD because they’re more effective. For example, antidepressants such as Zoloft, Paxil, Prozac, and Effexor raise the brain’s level of serotonin, a chemical that reduces symptoms of depression and anxiety. 

“In contrast to benzodiazepines, these medications [antidepressants] can be used with trauma-focused psychotherapy,” Sarmiento said. Those therapies include talking or writing about traumatic events, or learning and practicing meditation or deep-breathing exercises to manage anxiety.

“Treatment should be tailored to the individual patient,” Sarmiento said. 

Sarmiento notes that throughout the MHS, benzo prescriptions have been on a downward trend since peaking in 2012. “And from available pharmacy data, we know that the medications recommended for PTSD are appropriately trending upward,” he said.

Roberts said a prototype of the reviewing and monitoring tool was developed in February 2017. It was updated in September to reflect the revised VA/DoD clinical practice guideline for the management of PTSD and acute stress disorder. The tool generates quarterly reports that the DHA Pharmacy Operations Division sends to the three service surgeon general staffs to distribute to military treatment facility leaders.

“MTF commanders have the information to know what the prescribing practices are for PTSD patients at their particular facility,” Roberts said. 

According to the tool, the number of benzos prescriptions for MHS beneficiaries diagnosed with PTSD dropped from 1,922 in the first quarter of fiscal year 2017 to 1,749 in the fourth quarter, a decline of about 9 percent. Data for the first quarter of FY 2018 was released this month. It shows the number dropped again — to 1,651.

“In June, we’ll assess trends based on second-quarter data,” Sarmiento said. “If the prescribing rate doesn’t continue declining, we’ll implement one-on-one education between clinical leadership and their high-prescribing providers.”

Meanwhile, Sarmiento encourages patients who’ve been diagnosed with PTSD to talk with their providers. “We want them to feel empowered to ask questions and understand their individual treatment plan,” he said. 


You also may be interested in...

DoD, Air Force medical leaders visit JB Charleston

Article
8/13/2018
Navy Vice Adm. Raquel Bono, Defense Health Agency director, answers questions during a medical group meeting at Joint Base Charleston. The visit consisted of a consolidated mission brief, a strategic discussion with military medical senior leadership, a 628th Medical Group facility walking tour and ended with an in-depth question and answer session regarding the transition of Air Force military treatment facilities to DHA. (U.S. Air Force photo by Airman 1st Class Helena Owens)

By October 2021, all military treatment facilities to include overseas facilities are scheduled to transition to DHA management

Recommended Content:

Military Hospitals and Clinics

Drug-monitoring innovations help providers help their patients

Article
8/6/2018
Two Military Health System innovations are helping to ensure best practices for patients with pain, and for patients who’ve been diagnosed with post-traumatic stress disorder. (U.S. Air Force photo by Senior Airman Curt Beach)

Focus is on management of pain and PTSD

Recommended Content:

Innovation | Substance Abuse | Posttraumatic Stress Disorder

Shanahan discusses medical readiness, DHA transfer at Womack

Article
8/1/2018
Deputy Defense Secretary Patrick M. Shanahan greets Veterans Affairs Secretary Robert Wilkie as Army Col. John Melton, the commander of Womack Army Medical Center, looks on, at the start of a meeting at Womack Army Medical Center, Fort Bragg, North Carolina, July 26, 2018. Shanahan convened the meeting to discuss medical readiness, as well as how the Defense Health Agency and military services are collaborating on the integration of the Military Health System. (DoD photo by Lisa Ferdinando)

The fiscal year 2017 National Defense Authorization Act transfers the administration and management of military medical treatment facilities to the DHA beginning Oct. 1, 2018

Recommended Content:

Health Readiness | Military Hospitals and Clinics

NMC Camp Lejeune: 75 years of service expands to civilian community

Article
7/31/2018
Naval Medical Center Camp Lejeune in Jacksonville, North Carolina, was commissioned as Naval Hospital Camp Lejeune in May 1943. Today, the medical center serves a military-connected community of approximately 155,000. (Courtesy photo)

Trauma verification helps providers keep skills sharp

Recommended Content:

Military Hospitals and Clinics

Leaders come together to rehearse military healthcare transition

Article
7/31/2018
Leaders from across the Department of Defense, the Army and Fort Bragg meet at U.S. Army Forces Command headquarters July 19, 2018, to discuss the upcoming transition of the administration and management of Womack Army Medical Center from the U.S. Army Medical Command to the Defense Health Agency. (U.S. Army photo by Eve Meinhardt)

There should be zero impact on delivery of medical services that support readiness of the force

Recommended Content:

Health Readiness | Military Hospitals and Clinics

DHA PI 6490.01: BH Treatment and Outcomes Monitoring

Policy

This Defense Health Agency-Procedural Instruction (DHA-PI), based on the authority of References (a) and (b), and in accordance with the guidance of References (c) through (k): a. Establishes the Defense Health Agency’s (DHA) procedures for the collection and analysis of BH outcome data. b. Addresses how DoD will standardize BH outcome data collection to: assess variations in mental health and substance use care among in-garrison medical treatment facilities (MTFs) and clinics; assess the relationship of treatment protocols and practices to BH outcomes; and identify barriers to provider implementation of evidence-based clinical guidance approved by DoD. c. Designates the Army as the DoD lead Service for maintenance and sustainment of the Behavioral Health Data Portal (BHDP) in specialty care mental health and substance use clinics, referred to collectively as BH clinics, until BHDP functionality can be integrated with GENESIS or another electronic health record (EHR) system managed by DHA. d. Designates DHA Information Operations (J-6) as lead on transitioning BHDP functional requirements related to outcomes monitoring to future EHR data collection platforms and processes.

There is hope

Article
7/11/2018
Medically assisted treatment for opioid use can break the cycle of addiction.

More than 350,000 deaths are attributed to opioid overdoses nationwide since 1999

Recommended Content:

Mental Health Care | Substance Abuse | Addiction | Mental Wellness

Breaking down anxiety one fear at a time

Article
6/5/2018
Marine Staff Sgt. Andrew Gales participates in ‘battlefield’ acupuncture, also known as ‘ear acupuncture,’ at Walter Reed National Military Medical Center, as a treatment for anxiety related to PTSD. (U.S. Navy photo courtesy Mass Communication Specialist 2nd Class Kevin Cunningham)

Generalized anxiety, panic disorder, and anxiety related to PTSD are common disorders. In fact, an estimated 31 percent of U.S. adults experience anxiety at some point in their lives; one marine discusses his journey.

Recommended Content:

Mental Health Care | Preventive Health | Men's Health | Mental Wellness | Posttraumatic Stress Disorder

Two MHS providers achieve top scores in the patient experience survey

Article
6/4/2018
Recently, the MHS published its annual “Best of the Best” report, taking a closer look on MHS providers, departments and facilities who earned top honors based on JOES survey results.

The MHS recently published its annual “Best of the Best” report on medical providers

Recommended Content:

Military Hospitals and Clinics | Quality and Safety of Health Care (for Healthcare Professionals)

Project Sea Raven delivers cutting-edge pathogen detection technology

Article
5/31/2018
U.S. Navy Petty Officer 1st Class James Bowes, senior preventive-medicine technician, places mosquitoes on a dish to view under a microscope. Project Sea Raven’s capabilities are not limited to just insects – it can test anything from blood to soil and water. (U.S. Navy photo by Petty Officer 1st Class Tom Ouellette)

Project Sea Raven is now an integral part of USNS Mercy’s microbiology capacity

Recommended Content:

Global Health Engagement | Technology | Military Hospitals and Clinics

Assess your mental wellness during Mental Health Awareness Month

Article
5/25/2018
Similar to physical health, mental health requires regular care. Mental health is as critical as physical health to mission readiness. Therefore, it’s just as important to invest in your mental health as it is your physical health. (U.S. Air Force photo)

TRICARE provides mental health services for you and your family at all times

Recommended Content:

Mental Health Care | Mental Wellness | Men's Health | TRICARE Health Program

TRICARE Mental Health

Video
5/24/2018
TRICARE Mental Health

Watch this video to learn more about the mental health care benefits TRICARE provides

Recommended Content:

Mental Health Care

Breaking down the image: Mental health

Article
5/22/2018
Kevin Hines, a suicide survivor and activist for suicide prevention, speaks to Airmen assigned to the 28th Bomb Wing about his story at Ellsworth Air Force Base, South Dakota. Hines is one of 36 people to survive a suicide attempt by jumping off the Golden Gate Bridge, San Francisco, California. (U.S. Air Force photo by Airman 1st Class Nicolas Z. Erwin)

May has been National Mental Health Month since 1949

Recommended Content:

Mental Health Care | Health Readiness | Mental Wellness

Years in the making: How the risk for Alzheimer’s disease can be reduced

Article
5/18/2018
According to the Centers for Disease Control and Prevention, about 5.5 million Americans, up to 1.7 percent of the population, may have Alzheimer’s disease. Symptoms such as memory problems, impaired reasoning or judgment, vision or spatial issues, and difficulty finding words can indicate early stages of the disease. (U.S. Army graphic)

About 3 million new cases of Alzheimer’s Disease, the most common form of dementia, are diagnosed every year. Experts say lifestyle modifications can help prevent this disease.

Recommended Content:

Mental Health Care | Mental Wellness

Making behavioral health care easy

Article
5/11/2018
Army Staff Sgt. Michael McMillan (right), 35th Infantry Division behavioral health noncommissioned officer in charge, confers with Army Capt. Trever Patton, 35th ID psychologist, in Kuwait. Embedded behavioral health teams are a key part of providing easy access to care for service members. (Army photo by Staff Sgt. Tina Villalobos)

Embedded behavioral health teams let service members easily access behavioral health care right in their unit areas

Recommended Content:

Mental Health Care | Mental Wellness
<< < 1 2 3 4 5  ... > >> 
Showing results 1 - 15 Page 1 of 11

DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101

Some documents are presented in Portable Document Format (PDF). A PDF reader is required for viewing. Download a PDF Reader or learn more about PDFs.