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Physicians interviewed by the AP said they began prescribing Seroquel because it was the only drug that offered relief from the nightmares and anxiety of PTSD.
"By accident, some people were giving them Seroquel for anxiety or depression, and the veterans said, 'This is the first time I have slept six or seven hours straight all night. Please give me more of that.' And the word spread," said Dr. Henry Nasrallah of the University of Cincinnati, who has treated PTSD patients for more than 25 years.
Most of the soldiers and veterans seeking treatment for PTSD do so at hospitals run by the VA or the Defense Department.
The VA's spending on Seroquel has increased more than 770 percent since 2001. In that same time frame, the number of patients covered by the VA increased just 34 percent.
Seroquel has been the VA's second-biggest prescription drug expenditure since 2007, behind the blood-thinner Plavix. The agency spent $125.4 million last fiscal year on Seroquel, up from $14.4 million in 2001.
Spending on Seroquel by the Department of Defense, has increased nearly 700 percent since 2001, to $8.6 million last year, according to purchase records.
Nasrallah and others said they use drugs like Seroquel off-label because so few treatments are approved for PTSD. The FDA has only cleared two drugs for the condition, the antidepressants Paxil and Zoloft, and they do not always work.
The only published study on use of Seroquel for PTSD-related insomnia involved just 20 patients who were followed for six weeks at a VA medical center in South Carolina. The study, which showed moderate improvement in sleep, was funded by AstraZeneca at the request of VA psychiatrist Dr. Mark Hamner, who has studied the use of Seroquel for PTSD.
In his written conclusion, published in 2003, Hamner urged caution in interpreting the results because of the study's small size and short duration.
Hamner is working on larger, federally funded studies of Seroquel. For now, he acknowledges, there is little published research on the use of the drug for PTSD.
"Clinical judgment is really the best we can use at this time because there isn't really a good database to facilitate decision-making," said Hamner, who works at the Ralph H. Johnson Medical Center in Charleston, S.C.
He stressed that VA guidelines require doctors to monitor patients for dangerous side effects with drugs like Seroquel.
The drug, approved in 1997, is AstraZeneca's second-best-selling product, with U.S. sales of $4.2 billion last year. But that success has been marred by allegations that the company illegally marketed the drug and minimized its risks. AstraZeneca agreed to pay $520 million in April to settle federal allegations that its salespeople pitched Seroquel for numerous off-label uses, including insomnia.
Pharmaceutical companies are prohibited from marketing drugs for unapproved uses. AstraZeneca also faces an estimated 10,000 product liability lawsuits, most alleging that Seroquel caused diabetes.
Since White died, his family has been searching for an explanation -- and for a way to prevent other deaths.
"We trusted the knowledge of the physicians, that they weren't going to do any harm," White's father said. "And we also trusted the drug companies because that's who provides the research for the physicians. That's what our battle is now: trying to get changes made."
Copyright 2010 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
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