Antipsychotic and mood stabilizer receipt for Veterans Affairs patients with PTSD: A national investigation

Abstract: Objective: Treatment guidelines recommend only a few medications for the treatment of posttraumatic stress disorder (PTSD). There is substantial guideline-nonconcordant treatment for individuals with PTSD, including antipsychotics and mood stabilizers, which have potentially serious adverse side effects. As part of health system monitoring, we examined patient and clinical factors that may be associated with prescribing these medications among Veterans Health Administration (VHA) patients diagnosed with PTSD and without diagnosed comorbid bipolar or psychotic disorders. Method: The study cohort included all VHA patients with PTSD diagnoses in fiscal year 2019 who did not have comorbid diagnoses of schizophrenia, psychotic spectrum disorders, bipolar disorder, or major depressive disorder with psychotic features in fiscal year 2019 or the prior two fiscal years (N = 122,292). Logistic regressions assessed demographic (e.g., age, race) and clinical (e.g., psychiatric diagnosis, health care engagement) factors associated with antipsychotic and mood stabilizer prescription receipt. Results: 11.9% of the cohort received an antipsychotic, the strongest predictors of which were the presence of a suicide risk flag (adjusted odds ratio [aOR] = 1.57) and benzodiazepine prescription (aOR = 1.79). 12.4% of the cohort received a mood stabilizer, the strongest predictors of which were a service-connected disability above 70% (aOR = 1.56) and a comorbid personality disorder diagnosis (aOR = 1.76). Conclusions: VHA patients with PTSD who have psychiatric comorbidity and receive multiple psychiatric medications were more likely to receive guideline-nonconcordant mood stabilizers and antipsychotics. Additional work is needed to better understand the impact of these prescribing practices to help providers balance the risks and benefits of these medication combinations.