Friday, October 19, 2007

Panel Sees No Clear Aid for Veterans Under Stress

October 19, 2007

WASHINGTON, Oct. 18 (Reuters) — Many veterans of combat in Iraq and Afghanistan are clearly suffering from post-traumatic stress disorder, but it is not at all clear which treatments work to help them, an expert panel from the Institute of Medicine reported Thursday.

The only treatment that has been shown to work, the panel said, is exposure therapy, a gradual, step-by-step process in which patients are asked to confront memories of a trauma by recounting it in detail. Veterans Affairs hospitals now use that treatment.

“At this time, we can make no judgment about the effectiveness of most psychotherapies or about any medications in helping patients with P.T.S.D.,” said the panel’s chairman, Dr. Alfred Berg of the University of Washington, Seattle.

“These therapies may or may not be effective — we just don’t know in the absence of good data,” Dr. Berg said. “Our findings underscore the urgent need for high-quality studies that can assist clinicians in providing the best possible care to veterans and others who suffer from this serious disorder.”

Post-traumatic stress disorder is the most commonly diagnosed service-related mental disorder among military personnel returning from Iraq and Afghanistan. The panel quoted surveys showing that 12.6 percent of troops who fought in Iraq and 6.2 percent who were in Afghanistan have experienced it.

The experts, who were appointed by the institute, the medical arm of the National Academy of Sciences, reviewed 53 studies of drugs and 37 studies of psychotherapy approaches used to treat the stress disorder. They found most of the studies lacking.

“The majority of drug studies have been funded by the pharmaceutical manufacturers, and the majority of psychotherapy studies have been conducted by the individuals who developed the techniques or their close collaborators,” the panel said in a statement.

Drugs studied included anticonvulsants, antipsychotics, tranquilizers and antidepressants. Several studies were flawed because participants discontinued treatment, the panel said.

It concluded that the government and psychiatric researchers needed to take steps “to ensure that the right studies are undertaken to yield clearer, more reliable data that would help clinicians treat P.T.S.D. sufferers.”

Antonette Zeiss, the deputy chief of mental health services in the Department of Veterans Affairs, said that in using exposure therapy, the agency had taken the proven approach.

Doctors for the agency also use drugs in treating the disorder. In a statement, the department said it was important to note that the new report says only that “more research is needed, not that medications have been found to be ineffective.”

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