A service member was diagnosed with post-traumatic stress disorder but instead was found to have brain damage caused by a malaria drug.
• Timothy L. Solano/Marine Corps)The case of a service member diagnosed with post-traumatic stress disorder but found instead to have brain damage caused by a malaria drug raises questions about the origin of similar symptoms in other post-9/11 veterans.According to the case study published online in Drug Safety Case Reports in June, a U.S. military member sought treatment at Walter Reed National Military Medical Center in Bethesda, Maryland, for uncontrolled anger, insomnia, nightmares and memory loss.The once-active sailor, who ran marathons and deployed in 2009 to East Africa, reported stumbling frequently, arguing with his family and needing significant support from his staff while on the job due to cognitive issues.Physicians diagnosed the service member with anxiety, PTSD and a thiamine deficiency.
• But after months of treatment, including medication, behavioral therapy and daily doses of vitamins, little changed.The patient continued to be hobbled by his symptoms, eventually leaving the military on a medical discharge and questioning his abilities to function or take care of his children.It wasn’t until physicians took a hard look at his medical history, which included vertigo that began two months after his Africa deployment, that they suspected mefloquine poisoning: The medication once used widely by the U.S. armed forces to prevent and treat malaria has been linked to brain stem lesions and psychiatric symptoms.Troops get malaria during Ebola deploymentWhile no test is available to prove the sailor suffered what is called "mefloquine toxicity,” he scored high enough on an adverse drug reaction probability survey to tie his symptoms to the drug, also known as Lariam.The sailor told his Walter Reed doctors that he began experiencing vivid dreams and disequilibrium within two months of starting the required deployment protocol.And since the symptoms are so similar to PTSD, the researchers add, they serve to “confound the diagnosis” of either condition.“It demonstrates the difficulty in distinguishing from possible mefloquine-induced toxicity versus PTSD and raises some questions regarding possible linkages between the two diagnoses,” wrote Army Maj. Jeffrey Livezey, chief of clinical pharmacology at the Walter Reed Army Institute of Research, Silver Spring, Maryland.Once the U.S. military's malaria prophylactic of choice, favored for its once-a-week dosage regimen, mefloquine was designated the drug of last resort in 2013 by the Defense Department after the Food and Drug Administration slapped a boxed warning on its label, noting it can cause permanent psychiatric and neurological side effects,50,000 prescriptions in 2003At the peak of mefloquine's use in 2003, nearly 50,000 prescriptions were written by military doctors.That figure dropped to 216 prescriptions in 2015, according to data provided by the Defense Department.
• Shortly after commercial production began, stories surfaced about side effects, including hallucinations, delirium and psychoses.Once considered 'well-tolerated'Military researchers maintained, however, that it was a "well-tolerated drug," with one WRAIR scientist attributing reports of mefloquine-associated psychoses to a "herd mentality.
• ""Growing controversies over neurological side effects, though, are appearing in the literature, from journal articles to traveler’s magazines and resulting legal ramifications threaten global availability," wrote researcher Army Col. Wilbur Milhous in 2001.
• "Mefloquine was implicated in a series of murder-suicides at Fort Bragg, North Carolina, in 2002, and media reports also tied it to an uptick in military suicides in 2003.A 2004 Veterans Affairs Department memo urged doctors to refrain from prescribing mefloquine, citing individual cases of hallucinations, paranoia, suicidal thoughts, psychoses and more.The FDA black box warning nine years later led to a sharp decline in demand for the medication.
