A 37-year-old man set out for a trip to Nigeria with his family. Prior to the trip, the man had begun taking mefloquine, a drug derived from quinine, in order to protect himself against malaria, a deadly mosquito-borne virus. The trip was fairly uneventful, but two weeks after he returned home, he began to exhibit strange symptoms. He began to feel fatigued, and developing headaches. Worried that he had contracted malaria, the man took another dose of the mefloquine. The next day, he began to experience vertigo and couldn’t sleep. He began having pains in his chest and experiencing severe anxiety. His behavior began to change, and he began having unusual talks with his wife about religion, though his wife said it seemed he was having trouble following the conversations. His state worsened, and delusions began to manifest, the man had to be admitted to a psychiatric hospital.
In 2012, Army Staff Sgt. Robert Bales slipped away from his post in Afghanistan, wearing no body armor, a T-Shirt, night vision goggles, and a cape. He murdered 16 Afghani civilians, including 9 children. Side effects of mefloquine are believed to have been the cause.
Another man, 27 years old, took mefloquine for a trip to Africa, and several weeks after his return, his body was found in his home. The man appeared to have committed suicide by stabbing himself in his head with such force that the blade had broken off inside his skull. The man had no previous history of mental illness.
Over the past few decades, the psychiatric side effects of mefloquine, (brand name Lariam) have become disturbingly apparent. In the 1990’s, atrocities committed by the Canadian Airborne Regiment in Somalia were seemingly the result of mefloquine. Four soldiers at Fort Bragg murdered their wives before turning their weapon on themselves, and their sudden, unexpected change in behavior coincided with the administration of mefloquine.
While psychoses like the above cases are fairly rare, it appears that mefloquine can cause psychiatric problems, often long-lasting or permanent. These most frequently include depression and anxiety. However, mefloquine causes some side effect in up to 67% of users.
The history of mefloquine has its roots in the military, as the medication was first developed by the Walter Reed Army Institute of Research during the 1960′s and 1970′s. Though developed by the government, the formula and the rights associated with the drug were given to a private company free of charge. In the 1990’s, concerns began surrounding the neuropsychiatric effects of mefloquine, but were largely ignored until 2002, when the FDA warned of reactions including depression, paranoia, hallucinations, anxiety, convulsions and psychotic behavior. It wasn’t until 2013 when the US military declared it as a drug of “last resort,” and stopped regularly administering the drug to its troops.
While we do not fully understand how mefloquine can cause these symptoms, it is believed that it interferes with the ability of neurons in the oldest parts of the brain, which are related to learning, memory formation, emotions and stress responses.
Neurological symptoms from mefloquine toxicity can include:
- Peripheral neuropathy/polyneuropathy
- Dysesthesias (unpleasant feeling of touch)
- Paresthesias (pins and needles)
- Ataxia (loss of control of movement)
- Vertigo (dizziness)
- Visual difficulties
Psychiatric symptoms from mefloquine toxicity can include:
- Panic attacks
- Paranoia/persecutory delusions
- Dissociative psychosis
- Amnesia and other memory problems
- Violent and suicidal behavior
Malaria is, of course, the deadliest disease in human history, and it is of the utmost importance for us to develop drugs to fight malaria safely. Drugs like mefloquine have saved hundreds of thousands, even millions of lives. However, it is also extremely important to carefully study the risks involved in new medications and to cease dispensing drugs when new information comes to light. Unfortunately, it took many years after these dangerous side effects were known for the military to cease dispensing mefloquine to American servicemembers.