On the year anniversary of the October 7, 2023 terror attacks, researchers from Kahn-Sagol-Maccabi (KSM), the Research and Innovation Center of Maccabi Health Services, revealed the results of a new study that provides insight into Israel’s nationwide collective trauma since the beginning of the Israel-Hamas war.
Dr. Tal Patalon, a palliative care physician and head of KSM, explained that the epidemiological research “shows the reaction on a national level with real world data, which is very difficult to find.”
The study collected anonymized medical data from 1.1 million people aged 21 and older in Israel from January 1, 2006 to July 31, 2024. After analyzing the data spanning 19 years, KSM researchers found a 317 percent spike in the likelihood of using short-term anti-anxiety medication, such as Xanax, since the October 7 terror attacks.
To put that figure in perspective, the study found a 28 percent increase in the likelihood of purchasing anti-anxiety medication while there were military conflicts, and during the 2006 Second Lebanon War, there was a 44 percent increase in that likelihood.
In the past, anxiety treatment patterns were location specific, but after the October 7 terror attacks, the KSM study found that the entire nation was adversely affected, with women being 81 percent more likely than men to start taking anxiety medication. That is a marked increase from the previous baseline of women being 26 percent more likely than men to be prescribed anxiety drugs during other military conflicts, according to the study.
Dr. Patalon stated in a press release, “The events of October 7 drastically changed reality for everyone – patients and healthcare providers alike. The sharp increase in anxiety medication use highlights the urgent need for tailored mental health interventions in acute setting during times of conflict.”
The Jewish Press spoke on the phone with Dr. Patalon about the unprecedented mental health crisis that Israel has been experiencing since the October 7 terror attacks.
The Jewish Press: As an emergency medical doctor and first responder, can you tell us about how the experience of trauma affects someone’s day-to-day life?
Dr. Patalon: Severe trauma can cause symptoms that will affect our three basic areas in life – the way we eat, nutrition, sleep and mood. If you don’t sleep well, then you get up tired, and then you’re more nervous, you don’t eat as well – you eat maybe in the middle of the night… (You drink) a lot of coffee to stay awake…that would definitely affect your mood. Trauma actually affects everything, and it really depends on the psychological, emotional state that the person is in at that specific time in his life.
Is there anything different about this study than other studies you’ve conducted in the past?
When we look at mental health, we usually address it on a personal level, very specific. And this is one of the first times we are doing the research that is population based. It’s not personal, it’s not per person, it’s per nation…. We covered 1.1 million people in retrospective data, and we looked at how does trauma affect the population.
Why do you think women are more likely to seek treatment for anxiety than men?
I think that women are less susceptible to the stigma of using benzodiazepines. (Also), from what I see in the clinic, many women ask for medication and then give it to their husbands.
Could you share with us your analysis of the graph that illustrates the number of first purchases of short-term anxiety medications by Maccabi Healthcare Service members between 2006 and 2024?
The graph is so dramatic. On October 7, the graph shows such an increase in the prescriptions. That is compared to every other war in Israel and military event, which is mind-blowing. This is just people, for the first time in their lives, (who) actually went and bought a benzodiazepine medication – a 300 percent more chance on October 7. Under a national threat, the whole country has a 300 percent chance of purchasing benzodiazepines, which is, by the way, not the right treatment.
Why are benzodiazepines not the correct treatment for trauma related symptoms – do you not even prescribe them temporarily?
We don’t give benzodiazepines as a first-line treatment because of the side effects and the addictiveness of the drug. It’s not just the addiction, it’s the tolerance, which means you will need a higher dose to get the same effect. You want to teach the patient tools so he can cope with the trauma, and deal with it and not (be) sedated. For elderly people – they can fall using benzodiazepines.
Why are benzodiazepines being so widely prescribed if they are not the right treatment? Is it because this is such an acute emergency situation?
I’m an emergency medicine physician, and a patient comes in and he says, “I cannot sleep at night; my son is in the army. I cannot sleep, I cannot eat, I cannot rest. I’m feeling crazy. I don’t have an appointment with a psychiatrist for two months. What can I do?”
As a family practitioner, I have no tools to help him in an immediate moment, except giving him something that will say, “Okay, this is like a stress reaction, I’ll give you something that will help you relax.”
It’s not only the patients (who) are under a severe trauma on a national level – in this situation, the ones who are treating you are also under an anxiety, so they are prescribing more. We need to provide care for first responders.
There is (also) no infrastructure that can support such an amount of mental health demand, from the HMO’s point of view, from the Ministry of Health perspective, we are not prepared to treat hundreds and thousands of patients with a mental health disorder in like 24, 48 hours.
Is anything being done to help the first responders?
In Maccabi, we opened the service for helping the workers, okay, giving help to the caregivers – physician, nurses, psychologists, whoever needs it.
Are there any protocols or references you can follow, or are you in completely un-chartered territory?
I’m an emergency medicine physician, and what we experienced – we don’t deal with that in emergency medicine. We have protocols for emergencies, like earthquakes, tsunamis, 911 events, but for a mental health mass casualty event, there are no protocols.
Are new avenues for medical treatment available now?
In Maccabi, we opened an online call center, and we gave more access to psychologists. We did virtual treatments with patients – we gave access virtually for support. We had to develop that in a very short time – a lot of services that did not exist before.
What are some of the recommended treatments for people who are traumatized?
It’s a multidisciplinary approach – a personalized plan of treatment made by a multidisciplinary team. When someone experiences a severe trauma, (there are) many techniques, like desensitization, biofeedback (and) psychology treatment…social workers. (There is also) trauma-focused psychotherapy, group therapy, Cognitive Behavioral Therapy (CBT), Eye Movement Desensitization and Reprocessing (EMDR), SSRI (selective serotonin reuptake inhibitor) and other possible medication at treating physician’s consideration. Social assistance (is also offered).
Can you describe how the desensitization method works?
In trauma, you take the patient into an area that is very similar or the same as the trauma, but you take him for one minute, and you bring him back, and then you take him for a longer time, or you simulate it, or you imagine with him that he is walking into that same situation and he comes out in a different way. There are many methods of desensitization. It means you experience it, but in lower controlled doses in a secure environment.
Can you tell us about the direction of your next area of research?
We are going to look at other types of medications, not just benzodiazepines – other types of medications. I’m looking at which type of people that actually started benzodiazepines on October 7 will continue to need antidepressant medication for the long term. If I know who the individuals are that are likely to deteriorate and to need chronic assistance, then I can target them in the next time – I can target them in real time, in acute state. If I know who’s going to deteriorate from acute to chronic, I can diagnose them earlier.
Are you planning to create a prognostic medical model to help practitioners categorize the needs of different patients?
The model that we are creating is the predictive model – we are trying to (predict) who are the patients that from the acute reaction will deteriorate into a chronic state…a chronic mental health problem (like) depression or PTSD. In emergency medicine, if you have a mass casualty event, you do a “triage” – in a walking clinic, everyone who comes through the door is black, red or green. Red if for emergency and black means he’s already dead.
In emergency medicine, in mental health, we don’t have a prioritization technique, and for a mass casualty event in mental health, we don’t have a triage.
In your Jerusalem Post Conference speech in June, you explained how you hope to use DNA sequencing and electronic medical records in the future to create algorithms with Artificial Intelligence (AI) that can find a better and earlier treatment for the patient. How far away do you think you are in creating a predictive model using this technology?
About a year and a half. DNA research is very expensive. [Right now we are using] the electronic medical record. The data in Israel is very detailed and very good and longitudinal, and you get the whole patient journey.
To read the full study (pre-print, yet to be peer-reviewed), please see www.medrxiv.org/content/10.1101/2024.10.04.24314902v1
To read Dr. Patalon’s speech at The Jerusalem Post Conference, visit www.facebook.com/ksminnovation/videos/dr-tal-patalon-presenting-at-the-jerusalem-post-annual-conference/477897104907987/
