US Troops - Malaria-Free
At What Price?

By H. N. O'Shannasey
Anxiety, depression, paranoia, ringing in the ear ñ these are components of a residual state all too often associated with soldiers in or returning from combat. It is also, however, a weekly dose of psychological instability that comes from a little white pill.
History has shown that the psychological scars of soldiers in combat run deep and are long-lasting, which is what makes the debate over an anti-malaria drug in use by our troops today controversial. Mefloquine hydrochloride, better know as Lariam, is thought to cause psychiatric symptoms, including hallucinations, psychotic behavior, even suicidal impulses. If this is an accurate assessment, then the use of it within the armed forces needs to be reevaluated. But how does one prove these detrimental side effects when warfare alone inflicts so much damage on the psyche?
Roche Pharmaceuticals, the maker of Lariam, acknowledges the possible side effects. The company goes so far as to mention in their Complete Product Information packet, "These symptoms have been reported to continue long after mefloquine has been stopped." This appears to be confirmed by widespread news reports of individuals having adverse mental health effects long after they stop taking the drug.
Regardless of the manufacturer's warnings, or reports linking the drug to psychotic behavior, Lariam is dispensed weekly to troops serving in the Middle East.
Since Lariam is not given exclusively to service members, it is easier to prove its negative effects. The incident of a soldier returning home from Afghanistan and killing his wife may be written off as the culminating effects of combat. What, then, can be deduced from the many travelers, and Peace Corps volunteers who also report suicidal impulses and psychological instability as a result of taking Lariam?
The criticism of Lariam in no way reduces the seriousness of malaria and the need to take preventative measures. However, other options do exist.
The Centers for Disease Control provide the public with several options for preventing malaria. In addition to Lariam, the other anti-malaria drugs available are autovaquone/proguanil (Malarone), doxycycline, chloroquine (Aralen), and hydroxychloroquine (Plaquenil). Common side effects all these drugs share are headache, stomach pain, nausea, blurred vision, and in the case of doxycyline, sun-sensitivity. The only drug to which psychological effects can be attributed is Lariam. The psychological effects are cited as being rare, but they are listed nonetheless.
The British Medical Journal in 1996 published a study regarding travelers and their ability to carry out their daily activities while taking anti-malaria drugs. Neuropsychiatric adverse events occurred at a rate of 1 in 140 people taking Lariam. The rate was 1 in 1,100 for those travelers taking Aralen or Malarone.
In 2001, European researchers conducted clinical trials, comparing the side effects of Lariam to the side effects of Malarone. Again, the test was conducted on travelers. The side effects of both drugs caused some patients to stop taking the drugs. The number to drop out was four times higher in the group taking Lariam.
Common sense: If the undesirable side-effects of a drug cause people to discontinue its use, and the drug is administered in the form of a pill, how many troops serving in the Middle East are not taking their anti-malaria drug? This leaves soldiers open to the risk of contracting malaria. The only solution to protecting the troops against malaria, meanwhile preserving their mental health, is to develop (or use an existing) treatment that has less perilous side effects.
Roche Pharmaceuticals mentions the varying side effects of other drugs as though Lariam is superior, claiming that "some may make your skin more sensitive to sunlight (Lariam does not do this)." This is an accurate statement, but a soldier with a sunburn is not as big a concern as a soldier suffering from paranoia and hallucinations. Add a weapon to the situation, and the soldier is not only a concern but a potential threat.
Combat is taxing enough on the human mind and body without adding the adverse psychological effects of Lariam. Yes, all drugs have side effects, but in most cases the choice to take these drugs lies with the individual. In the case of men and women serving their country, free will does not play a role in the prevention and treatment of theatre-specific diseases.
The troops in combat put their faith in the Department of Defense to make these choices in their best interest. The Department of Defense, in turn, should commit the resources to find an anti-malaria solution that poses little risk to the health and welfare of the troops.
- Guest Contributor H. N. OíShannasey is the pen name of an active-duty Marine Corps 1st lieutenant. She can be reached at h_n_oshannasey@sgtgrit.com.



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