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Malaria Drug Blamed for Paranoia, Hallucinations
San Diego Union-Tribune ^ | February 13, 2005 | Seth Hettena

Posted on 02/13/2005 8:28:19 AM PST by Scenic Sounds

As a volunteer firefighter, Georg-Andreas Pogany had seen disfigured bodies pulled from wrecked cars. But something very different happened when the Army interrogator saw the mangled remains of an Iraqi soldier.

He became panicked, disoriented and that night reached for both his loaded pistol and rifle as he thought he saw the enemy bursting into his room. Pogany asked his superiors for help; the Army packed him home to face charges of cowardice – the first such case since Vietnam.

None of it made sense to Pogany until he learned more about the white pills the Army gave him each week to prevent malaria.

The drug's manufacturer warned of rare but severe side effects including paranoia and hallucinations. It became his defense: The pills made him snap. The Army dropped all charges, a spokesman later saying that Pogany "may have a medical problem that requires care and treatment."

Pogany is among the current or former troops sent to Iraq who claim that Lariam, the commercial name for the anti-malarial drug mefloquine, provoked disturbing and dangerous behavior. The families of some troops blame the drug for the suicides of their loved ones. Though the evidence is largely anecdotal, their stories have raised alarm in Congress, and the Pentagon has stopped giving out a pill it probably never needed to give troops in Iraq in the first place.

"What are we doing giving drugs that cause hallucinations, confusion, psychotic behavior to people that carry weapons and hold secret clearances?" asked Pogany, 33, who is now seeking a medical discharge. "It doesn't pass the common-sense test."

Former Army Spc. Don Dills and his wife say he grew anxious, paranoid and depressed after taking Lariam for seven months in Iraq. Dills, 22, says he "went crazy" on a family visit to Mississippi last year and wound up jailed for robbery. When Dills' wife called her husband's first sergeant about the arrest, he told her: Look into Lariam.

Dills, who like Pogany was based at Fort Carson, was kicked out of the military shortly after he wound up in a psychiatric ward for problems he and his wife contend are linked to Lariam.

"The bottom line is they know what's going on," said Elicia Dills, 25, of Pueblo, Colo. "They just don't know how to deal with the can of worms they opened."

The U.S. military, which developed the drug after the Vietnam War, won't say how many soldiers have complained about Lariam and won't detail how widely the drug was used in Iraq.

The Pentagon maintains that Lariam is safe and effective, though officials have expressed some concern and the military tells its pilots not to take Lariam.

In written guidance on the drug last year, the military urged commanders to send for a medical evaluation anyone who showed behavioral changes after taking the drug, "especially . . . if they carry a weapon" – a description of nearly all U.S. troops in Iraq.

"Delay could put the service member or your unit at risk," the guide said.

Lariam is among the drugs recommended by the U.S. Centers for Disease Control and Prevention for treatment and prevention of malaria, which kills about 1 million people worldwide each year. The drug's New Jersey-based manufacturer, Roche Pharmaceuticals, points out that more than 30 million people worldwide have used Lariam over 20 years.

"There is no reliable scientific evidence that Lariam is associated with violent acts or criminal conduct," Roche spokesman Terence Hurley wrote in an e-mailed response to questions.

Still, the pill has dedicated critics who believe it's causing problems that are only beginning to be understood. A review by the Department of Veterans' Affairs found 34 articles in medical journals about patients who took Lariam and became paranoid, psychotic or behaved strangely.

Within the civilian medical community, faith in the drug is mixed among doctors who specialize in tropical diseases. Two said they routinely prescribe it to travelers and believe troop complaints are overblown. Another criticized the military's use of a drug with a known history of psychiatric complications.

Dr. G. Richard Olds, professor and chairman of medicine at the Medical College of Wisconsin, is among Lariam's critics.

"There's a strong recommendation not to use Lariam for those who depend on fine motor skills," he said. "Do you call firing an M-16 a fine motor skill? I do."

Doctors at the Naval Medical Center in San Diego have diagnosed a disorder in the region of the brain that controls balance in 18 service members who took Lariam, among them Pogany.

Shortly after the March 2003 invasion of Iraq, military doctors determined another malaria drug would do the job with fewer side effects. Around the same time, the U.S. Food and Drug Administration announced that doctors should give patients revised information, underscoring that some Lariam users experience severe anxiety, paranoia, hallucinations, depression and think about killing themselves.

Troops were supposed to receive those kinds of warnings, but several current and former soldiers interviewed for this story said they did not – and that they continued taking the drug in Iraq as recently as 2004.

Concerns about those taking the drug weren't new. Some U.S. and Canadian forces deployed to Somalia in the early 1990s reported strange behavior. Last year, the assistant defense secretary for health affairs ordered a review of the drug's use based on troop concerns.

In a letter last month, Sen. Dianne Feinstein, D-Calif., pressed Defense Secretary Donald Rumsfeld to release results of the Pentagon's investigation. Feinstein has said there is enough evidence in the warnings from Lariam's maker "to make the causal link between the drug and many of the serious adverse events experienced by service members."

Military officials now concede Lariam wasn't needed in Iraq – and not just because, according to the Pentagon, no malaria infections have been reported among U.S. forces there.

Troops sent to Kuwait in 1991 for Operation Desert Storm were given another anti-malarial, chloroquine. Before the Iraq invasion, the Armed Forces Medical Intelligence Center in Fort Detrick, Md., which is charged with evaluating medical risks, was concerned that a deadly malaria strain in the region might have become resistant to chloroquine. They relied on reports from the World Health Organization and U.S. Special Operations units sent to northern Iraq.

In March 2003, U.S. Central Command recommended the use of Lariam or another drug, doxycycline, in high-risk areas in Iraq. Some commanders chose Lariam because it could be taken once a week rather than daily like doxycycline, whose main side effects included sensitivity to sunlight.

By July 2003, the military had determined the chloroquine-resistant strain wasn't in Iraq. Chloroquine then became the drug of choice.

TOPICS: Culture/Society; Government; News/Current Events
KEYWORDS: drugs; iraq; mentalhealth; sideeffects; turass; war
1 posted on 02/13/2005 8:28:20 AM PST by Scenic Sounds
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To: Scenic Sounds
As one who has bizarre reactions to many medications, I can understand this.
2 posted on 02/13/2005 8:36:41 AM PST by Ditter
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To: Scenic Sounds

I don't think there is much chance of contracting malaria in Iraq or other desert areas. But maybe I am mistaken.

3 posted on 02/13/2005 8:41:30 AM PST by jocon307 (Vote George Washington for the #1 spot)
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To: jocon307

Think rivers !
Lariam didn't bother me but some guys had trouble when taking it for long periods - I think it's recommended to give it a break after two or three months IIRC.

4 posted on 02/13/2005 9:06:26 AM PST by 1066AD
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To: Scenic Sounds

That is very strange, but I wonder if it explains some of the crazier behavior we've seen from the guys returning from the area.

5 posted on 02/13/2005 9:13:23 AM PST by conservative cat
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To: Scenic Sounds

Bring back DDT. It certainly would save a lot of lives.

6 posted on 02/13/2005 9:22:35 AM PST by Gatún(CraigIsaMangoTreeLawyer)
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To: Scenic Sounds
About six years ago I traveled to India on business and I was give the choice of taking Lariam or a second malaria medication (I can't remember the name). Lariam is a big pill that you take once a week, the other pill had to be taken twice a day for two weeks before leaving and for six weeks after your return. I was warned that taking Lariam "may" cause some side effects, but given the fact that I had never had a problem with prescribed meds in the past I opted for it anyway. I was in India for three and a half weeks and it was hell. The paranoia was unbearable, while there I sought medical attention numerous times, called home constantly, and had nightmares that scared the shit out of me. I can recall sitting in the Mumbai airport, going out of my mind convinced that I wouldn't make it back to the states alive. I truly believe that IF there is another option, the use of Lariam by our Military should be suspended.
7 posted on 02/13/2005 9:31:42 AM PST by got_moab? (59 million Bush fans can't be wrong)
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To: Scenic Sounds
Had the fears of Iraq having Chloroquine resistant malaria come true and we hadn't used drugs that covered it, the MSM would have had a field day about poor planning by Bush et. al. Instead they complain of the previously known side effects of the drug that covered the possible fear. The proper complaints should be, "Why don't we have better malaria drugs and why can't we use DDT."

The alternative drug, doxycycline, they could have used is safer EXCEPT that it often causes photosentivity, i.e. sun burning easily or rashes on sun exposed areas. Sunblock does NOT always prevent this. I've read reports that up to 40% get the side effect when full doses are taken, although I'd guess more like 10-15% of my many patients (mainly for bad acne) on it so complain. In the Iraqi sun you could have 10% of a unit unfit for duty from severe sunburns. The uncommon Lariam side effects were the lesser of evils.

8 posted on 02/13/2005 9:43:56 AM PST by JohnBovenmyer (I)
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