The military is seeing unprecedented mental illness and suicide in its ranks, and is funding research to treat depression and prevent the most tragic of outcomes.
In July, a report released by the military found that mental health disorders in active-duty troops increased 65 percent since 2000. Of the more than 900,000 diagnoses, about 85 percent included cases of adjustment disorders, depression, alcohol abuse and anxiety. This month, the Army reported 38 suspected suicides among active-duty and reserve soldiers in July, the highest monthly number of suicides since record-keeping began a few years ago.
Col. Carl Castro, director of the Military Operational Medicine Research Program, told NBC News that the military is "leaving no stone unturned" in its hunt to find evidence-based treatments for depression and suicide. Included in its multimillion dollar research portfolio is a grant to evaluate whether a nasal spray using a fast-acting hormone could alleviate symptoms of both depression and suicidal behavior.
The $2.9 million grant will support a three-year development and testing period that will ideally culminate in seeking Food and Drug Administration approval for the medication and delivery device. The grant was awarded in April to Dr. Michael Kubek, a professor of neurobiology at Indiana University.
Kubek will research the use of Thyrotropin-Releasing hormone (TRH), which is known to act rapidly in relieving depression and suicidal behavior. However, its effects are short-term and the hormone has difficulty crossing the blood-brain barrier. Kubek is aiming to load up nanoparticles with TRH and then deliver them via the nasal spray, which could lengthen the drug's effectiveness and overcome the challenges of getting past the blood-brain barrier.
The military is hopeful that the spray will provide a treatment for the period between when a patient is first diagnosed for depression or suicidal thoughts and when typical anti-depressants become fully effective, which can take three to six weeks.
The clinical trial will compare a few hundred patients split into two groups: one receiving the nasal spray and another getting a similar drug used to treat suicidal behavior and depression. The idea, Castro said, is to determine not only if the spray works, but if it is more effective than current drug therapies. The study will look at whether or not the drug decreases depression and suicidal thoughts.
Should the drug prove effective, Castro said a realistic timeline for putting it in a soldier's hands would be five to eight years to account for possible setbacks and additional studies.
The research is part of a $100 million effort to study psychological and mental illness in the Army. Half of that funding is for Army STARRS (Study To Assess Risk and Resilience in Servicemembers), an initiative done in partnership with the National Institute of Mental Health to gather details about the lives and mental health of 55,000 soldiers. The Army hopes that the epidemiological study may eventually identify groups of soldiers whose mental health is most fragile based on an algorithm or formula of factors.
The Army has allocated $18 million for 12 studies looking at treatment for depression and suicidal thoughts. The nasal spray study is the only one in the Army's portfolio to test a drug.
Despite the fact that suicide ranks in the top 10 leading causes of death in the U.S. — 36,909 people died by suicide in 2009 according to the latest available figures — clinicians still don't have a set of evidence-based standards for how to effectively treat suicidal patients. Instead, they rely often on a combination of medication and therapy that has shown promise, but has varying degrees of success.
The urgency to find a treatment has become critically important to the military as it searches for answers to its own suicide epidemic.
"We have no real explanation for why they're happening," Castro said of military suicides. The goal, he said, is to base treatment on science as opposed to "medical hunches."
The time it takes to design and execute a study can be frustrating to those waiting for an effective treatment, but Castro said, "at least at the end of the day, we'll know if something does work."
Rebecca Ruiz is a reporter at NBC News and a 2011-2012 Rosalynn Carter Mental Health Journalism Fellow. Follow her on Twitter here.
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