Mefloquine causes brain damage that mimics PTSD

As a rule, American U.S. Military service members that were deployed in regions where malaria was rife, Mefloquine (Lariam) was once the prophylactic of choice. Favored for its once-a-week dosage regimen, Mefloquine (Lariam) was designated the drug of last resort in 2013 by the Defense Department after the Food and Drug Administration slapped a boxed warning on its label, noting it can cause permanent psychiatric and neurological side effects[1].

At the peak of Mefloquine's use in 2003, nearly 50,000 prescriptions were written by military doctors. That figure dropped to 216 prescriptions in 2015 and it is prescribed only to personnel who can't tolerate other preventives.

Case reports of Mefloquine (Lariam) side effects have been published before, but now a case report has emerged in which a service member was diagnosed with post-traumatic stress disorder, but found instead to have brain damage caused by Mefloquine (Lariam)[2]. The case concerned a U.S. military member who sought treatment for uncontrolled anger, insomnia, nightmares and memory loss. Physicians diagnosed the patient with anxiety, Post-Traumatic Stress Disorder (PTSD) and a thiamine deficiency. But after months of treatment, including medication, behavioral therapy and daily doses of vitamins, little changed.

It wasn’t until physicians took a hard look at his medical history, which included vertigo that began two months after his Africa deployment, that they suspected Mefloquine (Lariam) poisoning. The medication has been linked to brain stem lesions and psychiatric symptoms before.

The case demonstrates the difficulty in distinguishing from possible Mefloquine-induced toxicity versus PTSD and raises some questions regarding possible linkages between the two diagnoses. It also raises questions about the origin of similar symptoms in others like victims of the illusive Gulf War Syndrome.

[1] Grabias et al: Adverse neuropsychiatric effects of antimalarial drugs in Expert Opinion of Drug Safety – 2016
[2] Livezey et al: Prolonged Neuropsychiatric Symptoms in a Military Service Member Exposed to Mefloquine in Drug Safety – Case Reports – 2016