Calling PTSD and traumatic brain injury "the signature wounds of the current war in Iraq and Afghanistan,"Rep. Bob Filner opened House committee hearings about soldier suicides. Testimony presented to the Veterans Committee also became a platform for understanding the complexity of evidence-based decision making with witnesses sparring over how research was conducted, and interpretations of the data. Questions about side-effects of antidepressants remain controversial and subject to strong opinion. They also have been used by the FDA to inform Black Box warnings, influenced prescribing patterns, created a media blitz, and prompted new programs from the military to identify soldiers and vets at risk.

The question of suicide risk and antidepressants was the committee's initial focus because combat-related stress, depression, PTSD, and suicide have reached unprecedented levels. Among those weighing in was psychiatrist Peter Breggin, author and long-standing critic of the new generation SSRI antidepressants used to treat depression. Breggin described his clinical experience and reviewed literature to argue that psychological tools should replace reliance on medication. "Little will be lost and much will be gained by curtailing the prescription of antidepressants in the military," he said.

Andrew C. Leon, a biostatistician in the psychiatry department at New York's Weill Cornell Medical College disagreed. He began by identifying a personal family connection to mental illness which guided his career choice. Leon pointed to data and spoke of his research career (including work for NIMH and the FDA) about antidepressants leading him to conclude there was a more likely increase in suicidal thinking, not actual suicide. A similar explanation came from the American Psychiatric Association's Dr. Annelle Primm. "From my perspective, as a psychiatrist, this is actually a good thing, because it means you have the opportunity to intervene and to keep the person safe." Interventions from psychologists engaged in behavioral therapy were addressed in an effort to outline the broad range of treatments.

Dr. Loree Sutton, Brig. General and psychiatrist, called medication "one tool in our tool kit" for understanding the unseen wounds of war. Suicide is not an academic discussion, she said, describing initiatives the military is developing to create a more seamless opportunity to identify and treat soldiers and vets. A study to assess risk and resilience begins next month. Sutton was critical of the discouraging tone of the hearings leaving an impression that antidepressants were dangerous rather than one of the choices, often used in combination with others, and closely monitored for risk.

The televised broadcast can be viewed here.