Central nervous system polytherapy among veterans with posttraumatic stress disorder: changes across a decade

The study objectives were to investigate rates and patterns of polytherapy among veterans with PTSD across time (in 2009 and 2019), describe features of polytherapy prescribing, and identify demographic and clinical factors associated with polytherapy.

Veterans Affairs (VA) administrative data were used to build cohorts of all VA-served veterans with PTSD in 2009 (N = 458,620) and 2019 (N = 877,785). Frequency of CNS active drug classes, rates of polytherapy (≥5 concurrent CNS drugs), clinical features associated with polytherapy, number of prescribers, and patterns of co-prescribed medications were examined.

The 12-month period prevalence of CNS polytherapy declined from 12.1% in 2009 to 6.9% in 2019. However, polytherapy rates increased from 3.3% in 2009 to 4.1% in 2019, when opioids and benzodiazepines were excluded. In multivariable regression analysis, CNS polytherapy was more common among women, White people, middle-age veterans (45-64 years), rural residents, veterans receiving care at a medical center, and those with psychiatric comorbidities. CNS polytherapy regimens involved a mean of 2.3 prescribers and the majority (86.6%) included at least one medication commonly prescribed for pain management.

CNS polytherapy declined among veterans with PTSD from 2009 to 2019 and was wholly attributable to decreases in opioid and benzodiazepine prescribing.