Gulf War syndrome symptoms persist in 1 in 3 vets, according to IOM report

By Deborah Kotz, Globe Staff

Remember Gulf War Syndrome, the vague illness that struck one in three veterans of the 1991 war in the Persian Gulf? Well, 175,000 to 250,000 of them are still experiencing symptoms of overwhelming fatigue, memory loss, anxiety, depression, and joint and muscle pain with little relief and sometimes little compassion from doctors, according to a new report issued by the Institute of Medicine.

The report analyzed the latest research on treatments and came to the conclusion that doctors shouldn’t recommend “one single therapy to manage the health of veterans” with the condition known as chronic multisymptom illness or CMI and shouldn’t take “a one-size-fits-all treatment approach.”

How is it distinct from post traumatic stress disorder? That’s not really clear, and the report’s authors -- physicians, psychologists, and public health experts from the Harvard School of Public Health and elsewhere -- wrote that veterans of the more recent Iraq and Afghanistan wars often have similar symptoms like sleep problems and chronic pain.

“Despite years of research,” wrote the study authors, “there is no consensus about what causes CMI, but there is a growing belief that no specific agent or causal factor will be identified.”

Given the prevalence of long-lasting health problems after military service, the IOM panel recommended better assessment and tracking of symptoms via electronic health records both for the patient’s benefit and to allow for more research into these conditions.

Treatment needs to be individualized, but evidence suggests that antidepressants and cognitive behavioral therapy -- a form of psychotherapy where a patient is taught to challenge negative thoughts about medical symptoms -- work best to alleviate a variety of symptoms, according to the report.

The specific antidepressants included in research studies were serotonin–norepinephrine reuptake inhibitors such as venlafaxine (Effexor) and duloxetine (Cymbalta) and selective serotonin reuptake inhibitors, such as citalopram (Celexa), escitalopram (Lexapro), or paroxetine (Paxil).

Cognitive behavioral therapy was assessed in six clinical trials where veterans with CMI had 5 to 12 individual weekly sessions for 50 to 90 minutes that were administered by a psychologist or general practitioner. Five of the six trials found that the behavioral therapy helped reduce symptoms better than standard medical care for up to 15 months of follow-up.

Other potential therapies including biofeedback, acupuncture, St. John’s wort, and exercise “hold promise” for treating CMI, according to the report, but require more studies to determine their true effectiveness.