Yesterday's "Buzz in the blogosphere" on the ScienceBlogs main page was all about medically unfit troops being sent in to battle. You should definitely check out some of those articles, including a discussion of whether the reports are accurate.
However, those reports don't cover another troubling phenomenon of the wars in Iraq and Afghanistan: the military's poor record handling mental illness. On Monday's Fresh Air, Terry Gross interviewed two reporters who had uncovered serious issues with the U.S. military's handling of life-threatening battlefield mental illness. They reported on the problem in the Hartford Courant back in May of 2006:
The use of psychiatric drugs has alarmed some medical experts and ethicists, who say the medications cannot be properly monitored in a war zone. The Army's own reports indicate that the availability and use of such medications in Iraq and Kuwait have increased since mid-2004, when a team of psychiatrists approved making Prozac, Zoloft, Trazodone, Ambien and other drugs more widely available throughout the combat zone."I can't imagine something more irresponsible than putting a soldier suffering from stress on SSRIs, when you know these drugs can cause people to become suicidal and homicidal," said Vera Sharav, president of the Alliance for Human Research Protection, a patient advocacy group. "You're creating chemically activated time bombs."
The rate of suicides on the battlefield nearly doubled from 2004 to 2005, and while the numbers are small in relative terms -- 22 suicides in 2005, the scale of the abuse makes one wonder whether using mentally unfit soldiers has other adverse effects -- on fellow soldiers, and on the people they are supposed to be protecting.
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The quote from Vera Sharav ignores the fact that SSRIs have only been documented to have these affects in children and teenagers; incidents of suicide and homicide were not significantly affected in adults. At least, to the best of my knowledge that's where the research stands. So unless we have 12 year old soldiers, I think giving them SSRIs is okay.
However, this says nothing of the ethics of doing it. Even if it's physically safe, there might be other reasons why it would be unethical to give them access to these drugs.
I don't think any psychiatrist would recommend using the drugs in a combat situation. According to the reporters, troops were given the drugs and then sent back to battle in just a few days, when the drugs take several *weeks* to have an effect.
Also, I don't know about the clinical research on these drugs, but many soldiers *are* teenagers -- 18- and 19-year-olds. Apparently the most common case of suicide is very shortly after deployment, within three months, so we may indeed be talking about very young soldiers.
As I'm sure you know, the standards for enlistment into the Army have dropped over the past few years to account for shortcomings in recruiting, so this may have recently changed, but the Army's policy is not to enlist anyone with a history of psychiatric disorders. That's defined several ways, including being treated for 6 months continuously, getting yourself put into a facility, legal problems resulting from your disorder, or even currently taking Ritalin. As was noted in the article, the argument is that people with psychological disorders that depend on medications to function normally can be a liability to their fellow troops if for some reason they can't get to their medicine. The point here is that you're unlikely to find new recruits who come into the military on meds.
It's considerably easier to stay in the Army once you're in, though, and hence you have the potential for vets returning to the war zone with all sorts of disabilities - physical and psychological. The glass-half-full side to this argument is that while numbers of disabled Soldiers are on the rise, it could be a lot worse; thanks to the increased survivability of our vehicles and other equipment, they're coming home missing a leg and not in a box.
Years ago, when I was a (cold war)Army Medic, The NATO accepted practice (based mostly on Israeli experience)for both acute(panic)and chronic (burnout)combat stress reactions was extremely anti-pharm but heavy on CBT within, or very close to, the patients home unit.
That might explain the "quick return" protocol which, if I recall the literature correctly, had a very significant effect on long term morbidity.
The only reason I can think of for the use of SSRI's/ other medication (based on my 25 year old knowledge) might have a lot to do with MD's trying to do their best with very little Mental Health training and support.
As to the issue of suicide, two thoughts spring to mind;
Suicide was always a problem in an environment of very young, aggressive...(narcissistic?).... males with lots of access to drugs, alcohol and weapons. I'd like to see a pre-war baseline before making any judgements about rates.
That said, and having worn the paint-by-numbers suit, would I believe any CSR/suicide stats I was given?
No.