Prescribing Trends in US Active Duty Service Members With Posttraumatic Stress Disorder: A Population-Based Study From 2007-2013

Objective: The US Veterans Affairs (VA)/Department of Defense (DoD) Posttraumatic Stress Disorder (PTSD) Clinical Practice Guidelines provide evidence-based pharmacologic treatment recommendations. Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are considered first-line medications. Benzodiazepines are relatively contraindicated with a warning that they may cause harm. This population-based study is the first to describe prescribing patterns for active duty service members (ADSMs) diagnosed with PTSD.

Methods: Health-care-related administrative DoD data from federal fiscal years 2007 through 2013 identified ADSMs with PTSD using ICD-9 codes. Prescription frequencies for antidepressants, benzodiazepines, antipsychotics, anticonvulsants, and other psychotropic medications were calculated for each year.

Results: Between 2007 and 2013, ADSMs with a PTSD diagnosis increased from 16,931 to 70,942. SSRI or SNRI prescribing decreased from 55.4% in 2007 to 41.8% in 2010 before increasing to 54.9% in 2013. Benzodiazepine prescribing was stable between 20.9% and 22.3% through 2010 before increasing to 24.7% by 2013. Antipsychotic prescribing declined from 22.6% in 2007 to 14.6% in 2013, driven by a decrease in low-dose quetiapine (≤ 300 mg/d) prescribing, which declined from 19.1% in 2007 to 8.2% in 2013.

Conclusions: The increase in SSRI or SNRI prescribing after 2010 and the overall increase in prazosin and decrease in low-dose quetiapine prescribing all suggest increased concordance with the VA/DoD PTSD Clinical Practice Guidelines. The decline in SSRI prescribing up to 2010 is not concordant. The increase in benzodiazepine prescribing, a trend opposite that observed in the VA, is concerning.