Does a Common Anti-Malarial Drug Cause Psychosis and Paranoia?
Following the case of former Staff Sergeant Robert Bales, who pled guilty to murdering 16 Afghan civilians – many of them women and children – to avoid the death penalty – reports have been circulating of a possible negative side effect of the anti-malarial drug Mefloquine, or Lariam. This drug is widely given to U.S. servicemembers deploying abroad as a prophylactic measure against malaria, and has also been demonstrated to be effective as a treatment for an active malarial infection as well.
However, some studies predating even the Iraq War have found that there does appear to be a link between the drug and severe episodes of paranoid psychosis, including this Israeli study from 1999. Further anecdotal evidence of Mefloquine-related psychosis is here, here, and here. CBS News took a closer look at the possible connection between violent psychotic episodes and Mefloquine in this 2009 article. And the United Kingdom news outlet, The Guardian, published this story in 2002.
Roche, the company that manufactures the drug, has acknowledged that the drug could cause serious psychological side effects on one individual in 10,000: A negligible percentage for any individual, but perhaps high enough for a large institution such as the U.S. Army requiring tens of thousands of troops to take the drug at a time. However, one study, published in the British Medical Journal in 1996, indicated that the negative side effects could affect as many as 1 in 150.
It is very difficult from a limited sample size with few meaningful opportunities for a controlled study with placebos to demonstrate a meaningful increase in problems among those taking the drug compared to those without it. Nevertheless, there are newer drugs available that seem to have fewer side effects that could be used in place of Mefloquin.
Indeed, the Army has severely rolled back its use among deployed troops, and issued guidance saying those with traumatic brain injuries (TBI) should not be taking the drug at all. Military doctors and commanders had been forcing troops to take the drug even where it was contraindicated.