Malaria is a major concern to troops who are deployed around the world where contracting the disease is a risk. It is the Department of Defense policy that service members deployed to these areas must take an anti-malaria drug. There are various drugs available such as doxycycline, chloroquine, malarone, and mefloquine. Each drug comes with its unique problems such as high monetary cost in the case of malarone and photosensitivity, nausea, vomiting, and resistance in the cases of doxycycline and chloroquine. Most anti-malaria drugs must also be taken once a day which causes problems with consistency and potency for the soldiers who miss a dose and for that reason Mefloquine, which is only taken once a week, has been prescribed. Mefloquine(Lariam®) may have a higher rate of compliance but it comes at a high cost to soldiers and American taxpayers. Mefloquine can cause brain injury, hallucinations, paranoia, psychosis and can predispose service members to Post Traumatic Stress Disorder (PTSD).
The military has been in the spotlight for various problems involving the mental health of its troops. The ghost of death and mental disease has been a difficult one to chase and various factors such as poor leadership have been overlooked in favor of other culprits. The increase in suicides has topped record highs and the increase in Post Traumatic Stress Disorder diagnosis and treatment is also on the rise. Mefloquine has become a suspect
in predisposing service members to mental illness including PTSD and Traumatic Brain Injury (TBI) which has lead to violence and suicide. The drug has been in use since the late 1970's and the problems with possible psychosis have been documented for decades, but is now gaining far more attention in the media and the government.
Mefloquine is receiving increasing attention in the media and the government due to the efforts of Dr. Remington Nevin
who is quickly emerging as an authority on the negative effects of the drug. Dr. Nevin says that mefloquine can cause limbic encephalopathy, an activation and stimulation of the emotional centers of the brain. The emotions stimulated by mefloquine include paranoia, horror, and anxiety that can lead to suicidal and homicidal ideations. In other words mefloquine's neurotoxicity can lead to psychosis.
Mefloquine has been flagged for contraindications with service members that already have suffered a TBI or have been diagnosed with PTSD because of the drug's neurotoxicity. However the neurotoxicity is now being looked into as a possible reason why service members are contracting TBI and PTSD with what seems to be less traumatic stimulation. In other words the brain has already been prepped by the mefloquine to be more easily injured.
It is easy to see how mefloquine has emerged as a possible reason for the increased number of TBI, PTSD, and suicides in the military. For example, people who suffer from Post Traumatic Stress Disorder have been found to have overactive amygdalas. Their fight or flight response has been turned on and turning it off is near impossible for the service members. A person with psychosis or who has overactive emotional centers is more predisposed to react negatively to battle stressors. Between the limbic encephalopathy and the over active fight or flight response it is no wonder that more service members are developing illnesses.
The increasing costs of treatment and lifetime disability through the VA due to PTSD and TBI has been cited as a concern to future Department of Defense budgets. It is estimated that it will cost billions of dollars to treat and provide disability and medical retirement benefits to American service members in the future. It is important to note, however, the reason mefloquine is being used despite the recorded negative side effects is because it costs far less than malarone
which is said to be safer.
The DoD is reassessing all information regarding mefloquine and seems to be addressing the problem. Time will tell whether or not service members will have to fight for proper recognition or treatment as in the cases of Agent Orange and Gulf War Syndrome.