June 27, 2022

Mefloquine, sold under names such as Lariam, is a medication used to help prevent malaria. I first experienced mefloquine when I landed in Afghanistan on January 3rd 2010, as we prepared to invade the city of Marjah.

Even on this night, this very eve, my mind troubles me. We are 2 weeks into the battle, the war inside my head replays the events as if it where yesterday. I now know that I am not alone, that many other veterans have experienced the side effects of this drug and the damaging effects it has had on our dreams.

Day and Night

I often would mistake dream from reality in the past(now I view it as a daily distraction, so I keep my mind busy), my thoughts are sometimes mistaken for interactions(but that is easily distinguished, I isolated myself in the beginning, now I have a lot of control but that took a lot of focus from within). I think I have communicated with someone, because the thought has occurred within my head, but often times the other person does not respond the way that I intend the conversation to go.
Mefloquine has also followed into my day dreams, the moments when you get lost in your thoughts and reflect on past events of where you have been or the things that you have seen. The longer the time goes, the more vivid the dream and thoughts become. At this point I have learned to enjoy the experience the thoughts have created. Isolation can be a companion, you don’t have to give power to your thoughts. I know that is easier said than done, thats why I practice it.

Mastering Yourself

Here is a brief overview of some of the things I have noticed help me with my thought process: I usually meditate in the sauna 20-60 minutes first thing in the morning while drinking a ton of water. Then I take a cold shower for 5-15 minutes. I find that the hot teaches you to breathe and the cold focuses your breath. Breathing gives you oxygen which brings dopamine, the natural body high, the feeling of the moment. It also helps with circulation and inflammation.
Fasting brings clarity. I only eat once a day, it also helps me regulate everything else. It is called intermittent fasting, I have posted on this blog about it. I also work out, unless I am injured, then I just rest. Working out is the most important part, you have to push past your pain by creating new pain every day through hard work.
The dreams might be more vivid now, a little intense even. But we have lived through them, we have seen what we dream face to face. Remember where you have been and teach people about why you went. Write down your dreams when you first wake up, this is going to take years. Do not give up, the dreams can change. Or at least the way you remember feeling will change.

Mefloquine Has Warnings Regarding Neuropsychiatric Disorders and Effects

Neuropsychiatric Disorders
[US Boxed Warning]: Do not prescribe for prophylaxis in patients with major psychiatric disorders including patients with active depression, a recent history of depression, generalized anxiety disorder, psychosis, schizophrenia; use is contraindicated in these patients. Use with caution in patients with a previous history of depression.

Neuropsychiatric Effects
[US Boxed Warning]: May cause neuropsychiatric adverse effects that can persist after mefloquine has been discontinued.
During prophylactic use, if symptoms occur, discontinue therapy and substitute an alternative medication. Symptoms may develop early in the course of therapy. Due to the difficulty in identifying these symptoms in infants and children, monitor closely especially in pediatric patients.
Psychiatric symptoms may include anxiety, paranoia, depression, hallucinations, and psychosis. Suicidal ideation and suicide have also been reported. Neurologic symptoms of dizziness or vertigo, tinnitus, and loss of balance may also occur and have been reported to be permanent in some cases. During prophylactic use, the occurrence of psychiatric symptoms such as acute anxiety, depression, restlessness, or confusion may be a prodrome to more serious neuropsychiatric adverse reactions. Use caution in activities requiring alertness and fine motor coordination (eg, driving, piloting planes, operating machinery) with neurologic symptoms.

Mefloquine and PTSD

Reviewed a few articles regarding Mefloquine and PTSD: Neuropsychiatric Outcomes After Mefloquine Exposure Among U.S. Military Service Members.
Eick-Cost AA1, Hu Z2, Rohrbeck P2, Clark LL2.

Mefloquine was widely prescribed to U.S. military service members until 2009 when use was limited to personnel with contraindications to doxycycline and no contraindications to mefloquine. The need to estimate the occurrence of neuropsychiatric outcomes (NPOs) in service members prescribed mefloquine warranted a comprehensive evaluation of this issue. Active component service members filling a prescription for mefloquine, doxycycline, or atovaquone/proguanil (A/P) between January 1, 2008 and June 30, 2013, were included in the analysis.
The risk of developing incident NPOs and the risk of subsequent NPOs among subjects with a history of the condition were assessed. A total of 367,840 individuals were evaluated (36,538 received mefloquine, 318,421 received doxycycline, and 12,881 received A/P). Among deployed individuals prescribed mefloquine, an increased risk of incident anxiety was seen when compared with doxycycline recipients (incidence rate ratio [IRR] = 1.12 [1.01-1.24]). Among non-deployed mefloquine recipients, an increased risk of post traumatic stress disorder (PTSD) was seen when compared with A/P recipients (IRR = 1.83 [1.07-3.14]). An increased risk of tinnitus was seen for both deployed and non-deployed mefloquine recipients compared with A/P recipients (IRR = 1.81 [1.18-2.79]), 1.51 (1.13-2.03), respectively). Six percent of the mefloquine cohort had an NPO in the year before receiving mefloquine. When comparing individuals with a prior neuropsychiatric history to those without, the ratio of relative risks for adjustment disorder, anxiety, insomnia, and PTSD were higher (not statistically significant) for mefloquine compared with doxycycline. These findings emphasize the continued need for physicians prescribing mefloquine to conduct contraindication screening

Psychiatric Side Effects of Mefloquine

Acute and long-term psychiatric side effects of mefloquine: a follow-up on Danish adverse event reports.
Ringqvist ?1, Bech P2, Glenth?j B3, Petersen E4.
The aim of the study was to explore the profile of acute and long-term psychiatric side effects associated with mefloquine.
Subjects (n = 73) reported to a Danish national register during five consecutive years for mefloquine associated side effects were included. Acute psychiatric side effects were retrospectively assessed using the SCL-90-R and questions based on Present State Examination (PSE). Subjects reporting suspected psychotic states were contacted for a personal PSE interview. Electronic records of psychiatric hospitalizations and diagnoses were cross- checked. Long-term effects were evaluated with SF 36. SCL-90-R and SF-36 data were compared to age- and gender matched controls.
In the SCL-90-R, clinically significant scores for anxiety, phobic anxiety and depression were found in 55%, 51%, and 44% of the mefloquine group. Substantial acute phase psychotic symptoms were found in 15% and were time-limited. Illusions/hallucinations were more frequently observed among women. Cases of hypomania/mania in the acute phase were 5.5%. Significant long-term mental health effects were demonstrated for the SF-36 subscales mental health (MH), role emotional (RE), and vitality (VT) in the mefloquine group compared to matched controls.
The most frequent acute psychiatric problems were anxiety, depression, and psychotic symptoms. Data indicated that subjects experiencing acute mefloquine adverse side effects may develop long-term mental health problems with a decreased sense of global quality of life with lack of energy, nervousness, and depression.

Length of Effects

Unable to identify whether or not neuropsychiatric side effects from taking mefloquine can affect an individual 9 years after exposure. Would be interesting to know if patient had an underlying MH condition prior to taking mefloquine.
Image from Vaccinationist, under CC BY-SA 4.0

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