Second generation antipsychotic prescribing patterns for veterans with posttraumatic stress disorder over a ten-year period

Purpose: This study examined the pattern of use of second generation antipsychotics (SGAs) in veterans with posttraumatic stress disorder (PTSD) over a 10-year period. The specific objectives were to determine the percentage of PTSD patients who were prescribed SGAs each year during the study period and to determine prescribing patterns for individual SGAs.

Methods: De-identified clinical data were retrieved from the VISN-7 Data Warehouse (includes 8 VA Medical Centers in Alabama, Georgia, and South Carolina). Patients with an ICD-9 code for PTSD (excluding bipolar, psychotic, and dementia diagnoses) in fiscal years 1999-2008 were selected for inclusion, and the electronic pharmacy database was examined for prescriptions for SGAs. Descriptive statistics were used to report data concerning prescribing patterns.

Results: The number of unique PTSD patients increased dramatically from 8,247 in 1999 to 28,309 in 2008. The percentage of PTSD patients prescribed an SGA increased steadily from 11.7% in 1999 to 31.9% in 2004, but then declined steadily to 18.5% by 2008. Prescribing patterns for individual SGAs showed variability over the study period, with the most striking examples being diminished use of olanzapine (approximately 50% of all SGA use in 1999-2000 vs. approximately 5% of all SGA use in 2006-2008) and increased use of quetiapine (approximately 10-15% of all SGA use in 1999-2000 vs. approximately 65-75% of all SGA use in 2003-2008). During the final years of the study period, patients who were prescribed quetiapine therapy were far more likely to receive high-dose (> 100 mg/day) therapy as opposed to low-dose therapy.

Conclusion: SGAs were widely used in the treatment of veterans with PTSD, and quetiapine was by far the most frequently prescribed SGA. Given the metabolic concerns associated with the use of SGAs, guidelines for their appropriate use in PTSD may be warranted.