Here's the transcript of the ANZAC eve Lateline Report 24/04/2013

Here's the transcript - thanks to the amazing team at ABC Australia's  Lateline.


TONY JONES, PRESENTER: Psychiatrists in Australia and

the US are calling for a review of the use of anti-psychotic medications to treat soldiers suffering post-traumatic stress disorder.

One drug in particular, Seroquel, which has the nickname "Suzie-Q", is being prescribed to get Australian soldiers to sleep when it was originally created to treat bipolar disorder and schizophrenia.

The Defence Department has confirmed an almost 600 per cent increase in scripts for the medication in just five years.

This report from Michael Vincent. The producer was Sashka Koloff.

MICHAEL VINCENT, REPORTER: For some soldiers, life has become regulated by endless packets of pills. Diagnosed with PTSD, their lives have been changed forever because of their experiences on the frontline.

"TROOPER M.": IEDs is a big thing. You're always worried about them, but, um ...


"TROOPER M.": Yeah. You, um, you know, we drove over one. You know, we had six cars go over one and then it went off, so.

MICHAEL VINCENT: "Trooper M." is just 23 years old. He served in a Special Forces unit in Afghanistan with comrades who were killed by Afghan colleagues.

"TROOPER M.": Then you think about, wow, you know, what if, um, you know, it was me that got murdered, not him, you know?

MICHAEL VINCENT: And it wasn't only death that distressed him.

"TROOPER M.": Over there they - a father had - they molest their kids and he (inaudible) child he had raped and he was just really concerned about his health and upset about his child and he'd raped his own child and seriously damaged his organs.

MICHAEL VINCENT: "Trooper M." sought help when the nightmares became too much.

"TROOPER M.": So the mental health nurse liaised with one of the medical officers, and from that - this is before I saw a psychiatrist or anything like that - they decided that Seroquel would be the choice of medication.

MICHAEL VINCENT: And why do you think they did that?

"TROOPER M.": I'm not sure. I never - I just followed what I was being told, pretty much, so.

MICHAEL VINCENT: Seroquel, also known by its generic name Quetiapine, was originally created to treat only bipolar disorder and schizophrenia. Then, in 2010, it was approved for use in Australia by the Therapeutic Goods Administration to treat generalised anxiety disorder and major depression with recommended doses of up to 150 milligrams daily.

But Defence offers soldiers up to 400 milligram tablets.

Lateline has been told that some soldiers are on up to 700 milligrams.

STAN CATTS, UNI. OF QUEENSLAND: If you are just simply trying to induce a degree of calm so that they can sleep better, then 50 or 100 milligrams ought to be enough. However if you're actually treating treatment resistant depression or treatment resistant arousal that's part of the PTSD syndrome, then you're probably going to need a higher dose. And sometimes with very complex disorders and where psychosis might be under consideration, you need much higher doses, 500 to 700 milligrams.

RICHARD A. FRIEDMAN, WEILL CORNELL MEDICAL COLLEGE: 700 milligrams is a whopping dose of Seroquel to give to a drug-naive person. My guess is 700 milligrams is given to people who've already experienced, you know, several hundred milligrams without an effect. That's a very, very large dose. That's clearly an anti-psychotic-sized dose of the drug.

MICHAEL VINCENT: What's the highest dosage of Seroquel that you've used?

"TROOPER M.": Say, maybe 250 milligram in one go. There has been slipups at times if I - because I was drinking a lot and I accidently took the 100 milligram tablets instead of the regular 25 milligram tablets. I accidently took about four of them, so I didn't wake up for over 24 hours. So, yeah.

MICHAEL VINCENT: "Trooper M." is not alone.

"CORPORAL J.": It's like a hangover. During the day when I was awake, I'd find myself, like, staring at a wall and drooling. People would ask if I was OK. These'd be senior officers. I'd be doing that for three to four hours while at work. I couldn't react. I was a blob, occupying the body of a soldier.

MICHAEL VINCENT: "Corporal J." has been a Special Forces soldier for 20 years. His words are being read by an actor to protect his identity.

"CORPORAL J.": I was on these drugs for six months when I was diagnosed with PTSD. That was what an Army psychiatrist informed me was the minimum treatment time under the guidelines. Afterwards it took me months to be weaned off it.

MICHAEL VINCENT: Lateline has spoken to Special Forces soldiers from Queensland, NSW and Victoria. All have PTSD. Some have received psychological counselling, some haven't. All say military doctors or GPs sanctioned by the Defence Department prescribed them Seroquel as a sedative just to get them to sleep.

STAN CATTS: If a veteran's getting sedation with Seroquel, it's not indicative of its therapeutic effect, it's indicative of its adverse effect. And that adverse effect should not be used as a way of treating a sleep disorder. You should treat the PTSD or depression that's the true cause of the sleep disorder.

MICHAEL VINCENT: Psychiatrist Professor Stan Catts has been studying Vietnam veterans with PTSD and their families for more than a decade. He says only psychological therapy is a proven treatment for PTSD, not the use of anti-psychotics.

STAN CATTS: I think the Seroquel issue is worrying because it's an indicator probably poor quality treatment. It's an indicator that a treatment that can administered in a minute of a prescription is being - is replacing intensive psychological treatments that require highly-trained staff and require a lot more time to administer.

MICHAEL VINCENT: The ADF's most recent figures show that eight per cent or almost 2,500 of its serving personnel suffer from PTSD.

In a statement to Lateline, Defence says soldiers are to be offered psychological therapy as a "first line treatment". But for patients where these treatments are less effective or those who, "... exhibit high levels of irritability, aggression or depression," medications like Seroquel can be used with careful monitoring.

The Defence Department says Seroquel is effective for insomnia and preferable to potentially addictive sleep drugs.

But Defence concedes its usage of Seroquel or Quetiapine has been steadily increasing. That's an understatement. In the past five years, the number of prescribed packages have jumped 573 per cent. Lateline's asked how many soldiers have been offered or have attended psychotherapy clinics. We haven't been given an answer.

The Department of Veterans Affairs deals with those who've left the service. It's told Lateline it provides phone counselling to thousands of veterans and their families. But just 155 former soldiers completed a PTSD group treatment program in the past financial year.

Veteran's Affairs also says it paid for almost 19,000 scripts for Quetiapine for 3,000 veterans or their relatives.

The increased usage of anti-psychotics is not just a concern in Australia.

RICHARD A. FRIEDMAN, WEILL CORNELL MEDICAL COLLEGE: What I discovered was that the military is using anti-psychotic drugs in our soldiers at rates that far exceed comparable rates in the civilian population. In other words, from 2005 to 2011 the rate of use of anti-psychotic drugs rose about 1,100 per cent.

MICHAEL VINCENT: Psychiatrist Professor Richard A. Friedman is from the Weill Cornell Medical Centre in New York. He's described the US military as operating a "psychoactive drug canteen".

RICHARD A. FRIEDMAN: Well, they're obviously using enormous amounts of anti-psychotic drugs off-label for purposes that they're really not intended or for indications that are way outside their usual use and way outside of what most psychiatrists and non-psychiatric physicians would ever use these drugs for.

MICHAEL VINCENT: A year ago the US Army's medical command was so alarmed about its soldiers use of anti-psychotics it issued new orders. It said there were "numerous concerns with potential long-term adverse health effects" from drugs like Seroquel or Quetiapine. Those drugs were taken off the inventory and the US Army's top doctor told care providers they had to get authorisation to prescribe it.

RICHARD A. FRIEDMAN: It was a recognition on their part that these drugs were being over-used or inappropriately used.

MICHAEL VINCENT: There's also new research from the United States pointing to serious health problems, including weight gain.

"CORPORAL J.": I went from 85 kilos to a rather sloppy 105. I was an elite specimen, and then I couldn't do anything. It's not good for your state of mind.

STAN CATTS: And if things like weight gain is not managed from the outset, then there are long-term risks that could in fact cause premature death through something called the metabolic syndrome leading to cardiovascular disease.

MICHAEL VINCENT: "Trooper M." is still using Seroquel a year after being prescribed it.

"TROOPER M.": Now I am at the stage where I cannot sleep without it. If I forget to take it, I will not sleep at night.

STAN CATTS: We've learnt an awful lot from our cohort of Vietnam veterans. They've taught us everything in a sense we know about PTSD resulting from combat. And we've heard incredibly sad stories about the suffering that they've gone through and that it's life-long. They put their lives on the line for us in a war and the least they can expect is the best quality treatment available.

"Trooper M." has now left the Army.

Michael Vincent, Lateline.

This is only the beginning. Get to know clarity. Email me, Mike Kennedy...

No comments: