scholarly journals Baseline Characteristics and Current Standard of Care (SOC) Among US Veterans with Major Depressive Disorder (MDD)

CNS Spectrums ◽  
2021 ◽  
Vol 26 (2) ◽  
pp. 174-175
Author(s):  
Swapna Karkare ◽  
Abigail Nash ◽  
Eileen Han ◽  
John J. Sheehan ◽  
Aimee Near ◽  
...  
Keyword(s):  
Standard Of Care ◽  
Veterans Health ◽  
Health Administration ◽  
Post Traumatic Stress ◽  
Current Standard ◽  
Major Depressive ◽  
Treatment Regimens ◽  
Adequate Dose ◽  
Post Traumatic ◽  
Line Of Therapy

AbstractStudy ObjectivesTo describe characteristics of veterans with MDD and the different treatment regimens received during the first observed and treated major depressive episode (MDE).MethodsA retrospective study was performed using the Veterans Health Administration (VHA) database from 4/1/2015 to 2/28/2019 (study period), supplemented with Medicare Part A/B/D data from 4/1/2015 to 12/31/2017. Adult veterans with ≥1 MDD diagnosis in the VHA database between 10/1/2015 and 2/28/2017 (index date) were included if they received ≥1 line of therapy (LOT) within a complete MDE. An MDE was considered as starting on the date of the first observed MDD diagnosis preceded by ≥6 months depression-free period (i.e. a period without an MDD diagnosis or antidepressant (AD) use); an MDE was considered as ended on the date of the last MDD diagnosis or the end of the medication supply of the last AD/augmentation medication, whichever came last and then followed by ≥6 months depression-free period. An MDE was required to begin and end during the study period. A LOT was defined as ≥1 AD at adequate dose and duration (≥6 weeks of continuous therapy with no gaps longer than 14 days) with or without an augmenting medication. Patients were required to have VA benefit enrollment for ≥6 months before (baseline) and ≥24 months after index (follow-up). Patient baseline demographic and clinical characteristics as well as the number and type of LOTs (up to the first six LOTs) received during the first observed and treated MDE were evaluated.ResultsOverall, 40,240 veterans with MDD were identified (mean ± standard deviation [SD] age: 50.9±16.3 years).The majority were male (83.9%), White (63.4%), and non-Hispanic (88.6%); 60.1% were unemployed or retired at some point during the study period. The most commonly observed baseline comorbidities included hypertension (27.5%), hyperlipidemia (20.8%), post-traumatic stress disorder (17.5%), and diabetes (14.8%). During the first observed and treated MDE (mean ± SD duration: 14.7 ± 8.6 months), patients received a mean of 1.6±1.0 LOTs, with 36.5% and 14.6% of patients receiving ≥2 and ≥3 LOTs, respectively; 0.8% of patients received ≥6 LOTs. The most commonly observed therapies were SSRI monotherapy (58.9%) followed by SNRI monotherapy (8.8%) in LOT1; SSRI monotherapy followed by AD augmented with anticonvulsants in LOT2 (SSRI monotherapy: 48.7%; AD augmentation with anticonvulsants:12.1%) and LOT3 (SSRI monotherapy: 43.5%; AD augmentation with anticonvulsants:15.0%).ConclusionsThis study used an episodic approach to evaluate the current standard of care among veterans with MDD. During the first observed and treated MDE, about one in seven veterans received ≥3 LOTs, suggesting presence of treatment-resistant MDD. Monotherapy with SSRIs or SNRIs and combination therapies of AD with anticonvulsants were the most common therapies in the first three LOTs.FundingJanssen Scientific Affairs, LLC

War-Worn Subjects

2020 ◽  
pp. 107-130
Author(s):  
Sara Rushing
Keyword(s):  
Veterans Health Administration ◽  
Medical Professionals ◽  
Veterans Health ◽  
Health Administration ◽  
Post Traumatic Stress ◽  
Post Traumatic ◽  
Wounded Warriors ◽  
A Site ◽  
And Control ◽  
The Military

This chapter explores how humility and autonomy come into play for “wounded warriors” seeking post-traumatic stress disorder (PTSD) treatment and for the medical professionals treating them within the particular constraints of the military-medical complex. Analyzing military PTSD illustrates how deeply entangled disease construction, diagnosis, and “cure” are with the complex discourse of “choice and control,” or with medicalization under the pressures of neoliberal rationality. Like with birth and death, but perhaps even more so, veteran PTSD as taken up within the Veterans Health Administration is a site of subjection and potential contestation from which we can learn much about the production of citizen-subjectivity in moments of distinct corporeal and psychic vulnerability. This chapter examines how militarism and masculinity conspire with inadequate conceptions of patient (and doctor) humility and autonomy, to produce an assumption of and fatalism about whether “wounded warriors” can be “fixed.”

scholarly journals The use of second generation antipsychotics for post-traumatic stress disorder in a US Veterans Health Administration Medical Center

2013 ◽  
Vol 23 (3) ◽  
pp. 281-288 ◽  
Author(s):  
E. Hermes ◽  
M. Sernyak ◽  
R. Rosenheck
Keyword(s):  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Second Generation ◽  
Stress Disorder ◽  
Medical Center ◽  
Veterans Health ◽  
Health Administration ◽  
Post Traumatic Stress ◽  
Chi Square ◽  
Post Traumatic

Background.Prior studies of antipsychotic use in individuals with post-traumatic stress disorder (PTSD) are limited because administrative data lacks information on why providers choose particular medications.Methods.This study examined 2613 provider surveys completed at the time any second generation antipsychotic (SGA) was prescribed over a 20-month period at a single Veterans Affairs medical center. Clinical correlates and reasons for SGA selection among individuals with PTSD compared to those with other psychiatric disorders were identified using chi-square.Results.PTSD was the sole diagnosis in n = 339 (13%) and one of several psychiatric diagnoses in n = 236 (9%) surveys. ‘Efficacy’ was the most common reason given for the prescriptions of SGAs in all surveys (51%) and among individuals with PTSD (46%). ‘Sleep/sedation’ was the only reason cited, significantly more frequently among those with PTSD (39% with PTSD only, 35% with PTSD plus another diagnosis, and 31% without PTSD [χ2 = 12.86, p < 0.0016)]. The proportion identifying ‘efficacy’ as a reason for SGA use was smaller in patients with PTSD (44% with PTSD only, 49% with PTSD and another diagnosis, and 53% without PTSD [χ2 = 8.78, p < 0.0125)]. Quetiapine was the most frequently prescribed SGA in the entire sample and among veterans with PTSD (47%).Conclusions.Clinician use of SGAs is often driven by efficacy, for which there is limited evidence, and distinctly driven by the goal of sedation among patients with PTSD.

On ‘moral injury’

2018 ◽  
Vol 31 (2) ◽  
pp. 128-146 ◽  
Author(s):  
Kenneth MacLeish
Keyword(s):  
Traumatic Stress ◽  
Clinical Psychologists ◽  
Moral Injury ◽  
Veterans Health ◽  
Health Administration ◽  
Post Traumatic Stress ◽  
Lethal Violence ◽  
Post Traumatic ◽  
Post War ◽  
Psychological Expertise

This article is concerned with theories and therapeutic practices that interpret post-traumatic combat stress as a ‘moral injury’ produced by the shock of carrying out lethal violence in uncertain battlefield conditions. While moral injury is said to share many symptoms with post-traumatic stress disorder (PTSD), its proponents – military and Veterans Health Administration clinical psychologists, chaplains, and some psychiatrists – are concerned by PTSD’s inability to account for the meaning-based moral and ethical distress that counterinsurgency battlefields in Iraq and Afghanistan are allegedly especially prone to produce in US soldiers. Moral injury theorists seem to want to describe a phenomenon that is both more profound than PTSD but which, as clinical psychologists Shira Maguen and Brett Litz state, is not itself a mental disorder. In this article, I examine the links between moral injury theory’s fringe diagnostic status and the fringe status of the kinds of violence it understands as uniquely injurious to soldiers’ psyches. Moral injury valorizes war-fighting and military culture while casting war as a source of almost inevitable psychopathology. I argue that moral injury theory represents an effort to carve out a distinct domain of psychological expertise but also a negotiation of the tension between war violence’s ‘normal’ practice and its excessive or morally hazardous manifestations – both of which link mental illness directly to the politics of war violence and post-war care.

scholarly journals The Role of HPA Axis and Allopregnanolone on the Neurobiology of Major Depressive Disorders and PTSD

2021 ◽  
Vol 22 (11) ◽  
pp. 5495
Author(s):  
Felipe Borges Almeida ◽  
Graziano Pinna ◽  
Helena Maria Tannhauser Barros
Keyword(s):  
Hpa Axis ◽  
Depressive Disorders ◽  
Post Traumatic Stress ◽  
Major Depressive ◽  
Physiological Adaptations ◽  
Suppression Test ◽  
Post Traumatic ◽  
Major Depressive Disorders ◽  
Cortisol Release

Under stressful conditions, the hypothalamic-pituitary-adrenal (HPA) axis acts to promote transitory physiological adaptations that are often resolved after the stressful stimulus is no longer present. In addition to corticosteroids (e.g., cortisol), the neurosteroid allopregnanolone (3α,5α-tetrahydroprogesterone, 3α-hydroxy-5α-pregnan-20-one) participates in negative feedback mechanisms that restore homeostasis. Chronic, repeated exposure to stress impairs the responsivity of the HPA axis and dampens allopregnanolone levels, participating in the etiopathology of psychiatric disorders, such as major depressive disorder (MDD) and post-traumatic stress disorder (PTSD). MDD and PTSD patients present abnormalities in the HPA axis regulation, such as altered cortisol levels or failure to suppress cortisol release in the dexamethasone suppression test. Herein, we review the neurophysiological role of allopregnanolone both as a potent and positive GABAergic neuromodulator but also in its capacity of inhibiting the HPA axis. The allopregnanolone function in the mechanisms that recapitulate stress-induced pathophysiology, including MDD and PTSD, and its potential as both a treatment target and as a biomarker for these disorders is discussed.

Use and correlates of VHA tobacco cessation counseling services by veterans with post-traumatic stress disorder

2017 ◽  
Vol 16 (1) ◽  
pp. 37-44 ◽  
Author(s):  
Megan Kelly ◽  
Shihwe Wang ◽  
Robert Rosenheck
Keyword(s):  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Tobacco Cessation ◽  
Stress Disorder ◽  
Fiscal Year ◽  
Counseling Services ◽  
Health Administration ◽  
Post Traumatic Stress ◽  
Content Type ◽  
Post Traumatic

Purpose Veterans with post-traumatic stress disorder (PTSD) have high lifetime rates of smoking and often have substantial difficulty quitting. However, relatively little research has focussed on the use of Veterans Health Administration (VHA) intensive tobacco cessation counseling services by veterans with PTSD and the characteristics of veterans with PTSD who do and do not use these services. The paper aims to discuss these issues. Design/methodology/approach The present study is an analysis of national VHA administrative data fiscal year 2012 that identified utilization rates of VHA intensive tobacco cessation counseling among veterans with diagnoses of both PTSD and tobacco use disorder (TUD) (N=144,990) and the correlates of tobacco cessation counseling use. Findings Altogether, 7,921 veterans with PTSD diagnosed with TUD used VHA tobacco cessation services (5.5 percent). Veterans with PTSD who used tobacco cessation counseling services were more likely to have been homeless, to have a comorbid drug use disorder, and had used other VHA services more frequently than their counterparts who did not access tobacco cessation counseling. The use of outpatient mental health and substance use services was the strongest correlate of tobacco cessation counseling use by veterans in this sample. Notably, veterans with PTSD, TUD and HIV were more likely to engage in tobacco cessation services. Originality/value This study demonstrates that future efforts should focus on increasing provider and veteran awareness of and accessibility to VHA intensive tobacco cessation counseling for veterans with PTSD.

A Case of Delayed Post-traumatic Stress Disorder with ‘Organic Memories’ Accompanying Therapy

1993 ◽  
Vol 163 (6) ◽  
pp. 828-830 ◽  
Author(s):  
Andrew C. Briggs
Keyword(s):  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Traffic Accident ◽  
Stress Disorder ◽  
Road Traffic ◽  
Post Traumatic Stress ◽  
Major Depressive ◽  
Major Disaster ◽  
Post Traumatic ◽  
Organic Memories

A case of post-traumatic stress disorder (PTSD) following a road traffic accident in which the onset of symptoms was delayed for 18 months until a widely reported major disaster occurred is described. A severe major depressive episode was precipitated, requiring treatment in its own right. During psychotherapy sessions, extreme emotions, heightened sensations, and ‘organic memories’ relating to the original accident were experienced.

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