Alexis McCabe

Five-year-old Alexis McCabe holds flags planted at the gravesite of her mother Army Pfc. Melissa Hobart.

Hobart was dutifully taking the Celexa she was prescribed to ease the anxiety of being separated from her young daughter while in Baghdad. She was given antidepressants to help make it through her tour of duty in Iraq -- she came home in a coffin. Hobart, 22, collapsed in June 2004 of an undetermined cause. (MARK MIRKO / April 18, 2006)

When Army Sgt. 1st Class Mark C. Warren was diagnosed with depression soon after his deployment to Iraq, a military doctor handed him a supply of the mood-altering drug Effexor.

Marine Pfc. Robert Allen Guy was given Zoloft to relieve the depression he developed in Iraq.

And Army Pfc. Melissa Hobart was dutifully taking the Celexa she was prescribed to ease the anxiety of being separated from her young daughter while in Baghdad.

All three were given antidepressants to help them make it through their tours of duty in Iraq -- and all came home in coffins.

Warren, 44, and Guy, 26, committed suicide last year, according to the military; Hobart, 22, collapsed in June 2004, of a still-undetermined cause.

The three are among a growing number of mentally troubled service members who are being kept in combat and treated with potent psychotropic medications -- a little-examined practice driven in part by a need to maintain troop strength.

Interviews with troops, families and medical experts, as well as autopsy and investigative reports obtained by The Courant, reveal that the emphasis on retention has had dangerous, and sometimes tragic, consequences.

Among The Courant's findings:

Antidepressant medications with potentially serious side effects are being dispensed with little or no monitoring and sometimes minimal counseling, despite FDA warnings that the drugs can increase suicidal thoughts.

Military doctors treating combat stress symptoms are sending some soldiers back to the front lines after rest and a three-day regimen of drugs -- even though experts say the drugs typically take two to six weeks to begin working.

The emphasis on maintaining troop numbers has led some military doctors to misjudge the severity of mental health symptoms.

Some of the practices are at odds with the military's own medical guidelines, which state that certain mental illnesses are incompatible with military service, and some medications are not suited for combat deployments. The practices also conflict with statements by top military health officials, who have indicated to Congress that psychiatric drugs are not being used to keep service members with serious disorders in combat.

In an interview Monday, Army Surgeon General Lt. Gen. Kevin C. Kiley insisted that the military uses psychiatric medications cautiously in the war zone, saying that medical professionals may prescribe them at low doses, "for very mild symptoms that might assist soldiers in transitioning through an event.'' He said the emphasis on keeping troubled troops close to the front lines is in the service members' best interests, because it helps them recover and avoid the stigma of abandoning their duty.

But many outside the chain of command see it differently.

"It's best -- for the Army,'' said Paul Rieckhoff, a former platoon leader in Iraq who said he was overruled when he tried to have a mentally ill soldier evacuated. "But find me an independent mental health expert who thinks that that's a proper course of action.''

Vera Sharav, president of the Alliance for Human Research Protection, a patient advocacy group, said retaining troops with mental disorders serious enough to require medication is "completely irresponsible.''

"It's really just plain dehumanizing. They are denying these guys a humane treatment, which is to get out of the battle,'' she said. "The best therapy for someone in that kind of stress is to get them out of the stress. The worst thing is to add a drug to this.''

Distributing Drugs

Some soldiers' advocates and medical experts criticize the military for taking an overly pharmacological approach to mental illness in an effort to retain troops, without proper oversight.