Lariam Dreams: Malaria or Madness?

John M. Edwards wonders whether taking the world’s strongest antimalarial drug might be worse than getting the dread eldritch disease itself?

“I dared to dream with my eyes wide open. . . .”

–T.E. Lawrence, The Seven Pillars of Wisdom

In Nairobi, Kenya, a man from Philadelphia loses it and leaps from a hotel’s second-story window. . . .

He is now a paraplegic.

At a Waldenbooks store, an ex Peace Corps worker goes psychotic and methodically destroys the paperback romance section. . . .

He is institutionalized.

In Southeast Asia, a traveler develops the delusion that a microchip has been planted in his brain so he can read minds. . . .

He undergoes extensive psychiatric treatment.

All of these stories, culled from the Internet, have one thing in common.

In London, England, a barrister suffers months of mental anguish after an East African trip. . . .

He commits suicide.

In Tanzania, a woman becomes convinced that she has committed some heinous crime and flies to Israel to hide out, destroying her American passport. . . .

The crime was imaginary.

In Afghanistan, an American serviceman opens fire on civilians in a village, killing sixteen people. . . .

He is tried for war crimes.

The list goes on and on with a series of class-action suits in the making.

What we are talking about is that all of the above took the world’s most powerful antimalarial, LARIAM ™, generically known as “mefloquine,” invented by Hoffman-La Roche of Switzerland and approved as a malaria prophylactic in 1989, the same company that brought us, in collaboration with the U.S. Army, LSD.

An idéa fixe of travel into the tropics, say the equatorial belt that wraps around the world like a batik sarong sash, is that if you don’t take a strong prophylactic against malaria, you are going to end up one unhappy camper, maybe even dead as a doornail (whatever that is).

Mefloquine is the recommended drug, taken weekly, in areas such as Sub-Saharan Africa, Southeast Asia, and South America—all places containing the chloroquine-resistant form of malaria called p. falciparum malaria, caused by the bite of the (female) Anopheles mosquito. But many users claim that the drug, to be blunt about it, caused madness, especially in those users who had had psychiatric troubles in the past.

Malaria, derived from the French “mal air” (bad air), is an infection of the blood caused by pernicious mozzies who feed, much like vampire bats, between dusk to dawn, Symptoms include fever, chills, muscle aches, headaches, vomiting, diarrhea, and coughing. If left untreated malaria can lead to kidney failure, convulsion, and coma. Over 200 million people contract malaria each year, and over 2 million people die from the disease each year.

What a nasty piece of business it is!

Still things could be worse, you could go stark raving mad.

Ask yourself, Malaria or Madness?

Tough choice.

Although malaria is treatable if detected early, there is no cure for what is now being called “mefloquine toxicity.” The symptoms are even worse than malaria: psychosis, hallucinations, delusions, panic attacks, insomnia, convulsions, depression, and terrifying dreams which can last for months, even years.

For example, during a six-month-long trip to Nigeria, a six-year-old girl fell ill, became delirious, and developed a skin rash that, upon her return to Great Britain, ate up the skin from ninety-five percent of her body. Her hair and nails fell out. Ulcers developed in her eyes. She suffered a heart attack and died. The culprit: Lariam poisoning.

While in West Africa in 1994, Kristin Loudis of San Francisco, California, USA, experienced terrifying Lariam dreams: “In one dream I was falling out of an airplane, with an Uzi machine gun, and blowing away all my friends and family on the way down.” Loudis also had another dream where soldiers in tanks were chasing her into a fenced-in cage full of ferocious German shepherds.

Eventually, Loudis’s nightmares spilled out into the wide-awake world. On the road, she felt like her head was “buzzing.” She complained about being possessed by “weird spirits.” And then on a pirogue on the Niger River in Mali, Loudis became paranoid that her good friends were plotting to drown her. “They kept shouting at me to come in the river: I hung on to the boat for dear life!”

Worsening matters, Loudis developed the symptoms of malaria and was hospitalized in Ghana, where she became delirious and kept asking, “Where is the Baby Jesus?! I know He is around here somewhere!” Even over a decade later after the ordeal she still reports unpleasant side effects.

Like many, in retrospect, Loudis says that she would not have used mefloquine if she had known the risks upfront—now all conveniently buried in the updated contraindications literature. “The drug is worse than malaria,” she believes.

In another case, also trusting his doctor’s advice over his own instincts, the Australian traveler Sheldon Johnston took Lariam when he set out for a hellish seven-month trans-Saharan trek in 1995. Before leaving he read the drug insert from the box which seemed to confirm that mefloquine was a pretty safe drug.

Or so he was led to believe.

Starting with mild side effects in Mauretania, Johnston at first put it all off to the stress of Third World travel. By the third week of mefloquine popping, Johnston was rather alarmed, especially when local doctors misdiagnosed his situation as “dehydration.” By the sixth week he was hospitalized in Lagos, Nigeria, where he was pumped with contraindicated drugs. Later in Douala, Cameroon, when a doctor bullied Johnston for a bribe, Johnston refused “halofantrine” (which can cause heart failure). Eventually, Johnston abandoned the trip and returned to London where doctors at the Hospital for Tropical Diseases correctly diagnosed him with “mefloquine poisoning.”

“One of the worst aspects of these neuro-toxic symptoms was the Third World setting in which I experienced them, not a pleasant place for a gravely ill person,” Johnston allows. Worse, was the “brain fog,” a 24-hour-a-day disability. “I was detached from the world, with headaches, dizziness, agarophobia, palpitations, and panic attacks.” The symptoms took over a year to subside.

One of the most outspoken critics of Lariam is Elisa Forgey, a former Ph.D. student of African and German History at the University of Pennsylvania, who describes the “unremitting nightmare” of dealing with long-term mefloquine poisoning as being “among the living dead.”

In 1995, Forgey traveled to “Zombie Apocalypse” Cameroon for pre-dissertation research, and shortly after taking her second-week Lariam pill, she came down with a long laundry list of symptoms, including chills that felt like “highly toxic bee stings.” Her side effects were so bad that she only averaged 45 minutes of sleep per night.”

The symptoms flared up again when Forgey drank a glass of Scotch (contraindicated with mefloquine), but nobody could figure out what was wrong with her, other than (possibly) “travel-related stress disorder”—a diagnosis dittoed by Dr. Hans Lobell of the CDC (Center for Disease Control). Other doctors assured her that Lariam couldn’t be the problem because it should already have been flushed out of the system, shouldn’t it?

Indeed, the medical community remains cautious, the CDC generally towing the line that getting malaria is much worse than the “rare possibility” of side effects. Dr. Karl Western, formerly of the NIH (National Institute of Health) remains cautious, while admitting that the drug is controversial among his colleagues. “Lariam is the most effective drug right now to combat malaria, and malaria can kill.”

But biological anthropologist M.K. Holder thinks the drug is a Pandora’s Box. “I strongly advise against taking Lariam, either as a prophylactic or as a curative dose. Most general practitioners in the U.S. have little or no training in tropical medicine . . . so they are very unlikely to provide a correct diagnosis when patients present these symptoms.”

Holder himself experienced several “Am-I-going-to-live-through-this?” effects while doing field work in Uganda in 1992. “I found myself wishing I had actually had malaria, rather than this self-induced torture.”

Even though Lariam has been known to trigger psychosis among those with a history of neuropsychiatric disorders (such as paranoid schizophrenia or bipolar mania), it is not known if it creates new problems for healthy individuals where none were before. Hoffman-La Roche claimed the chances of side effects was 1 in 10,000. But a U.K. study by the London School of Hygiene and Tropical Medicine and MASTA (Medical Advisory Service for Travellers Abroad) show the figure is closer to 1 in 140. Other more recent studies in the 21st century show the rate of significant side effects to be as high as 1 in 11. Any way you look at it, there are enough horror stories out there to at best give pause.

One of the most extreme cases of mefloquine nightmares I came across involved the delusions of a seasoned backpacking friend of mine on a 21st century trip to Vietnam. “ It was the most rotten vacation I have ever had,” he said. “Everywhere I went I was swarmed by desperate beggars wanting dollars.” It didn’t help his paranoia when one of his bus tours stopped for a “smoko” on a small strip of land going through rice paddies with rat cages similar to the ones used in The Deer Hunter.

“I thought I was going to go home in a body bag,” he admitted.

Near China Beach, my friend popped some Lariam and watched spectral lights resembling shooting stars, or rather comma-shaped comets, drop from the night sky like numinous punctuation marks nicked in by copyeditors at Der Spiegel.

Since he wasn’t sure what was in the “SPECIAL” pho soup he had just eaten, he wondered if he had been mistakenly dosed with psylocybin mushrooms. The hallucinations got worse each time he popped his weekly Lariam meds. He fancied he was going to finally really make contact with the aliens, whom in his unsettled state he thought might be the forerunners of the human race, not native to the earth, but instead came as colonists from way outside the Milky Way galaxy.

“I felt my soul was going AWOL!”

But he allows that some of the hallucinations during his Lariam-inspired “trips” were not exactly unpleasant, such as watching passively as the clouds formed into the shapes of pagan Aryan “Ramayana” shadow puppets.

Or, blue-faced blokes from the Bhagavad Gita.

These mefloquine-inspired delusions, although he knew they were not really true, proved difficult to deal with on long bus trips, which always felt like kidnapping. When he complained about his “tripping” on Lariam, a Swedish backpacking babe bruited: “Don’t take Lariam: I read in a newspaper in Stockholm that it can make you crazy!”

He is still suffering from crippling depression.

A support group of Lariam sufferers, Lariam Action USA, has documented a multitude of cases regarding “mefloquine poisoning,” while in the U.K. and U.S. several lawsuits are underway alleging that the manufacturer failed to warn them about potential side effects. Disgruntled freaked-out travelers can also file a Med-Watch adverse drug reaction report with the FDA (Federal Drug Administration): 800.332.1088.

Instead of Lariam, many people worldwide now use a combination of Proguanil and Doxycycline, which is difficult but not impossible to acquire in the United States.

Luckily, there is new hope on the horizon—an alternative malaria drug called “Malarone,” developed by Glaxo-Wellcome in the U.K.–which reportedly has minimal side effects. Even more hopeful is a new drug being tested from GlaxoSmithKline called “Mosquirix” ™.

But, it is telling that North American troops in Somalia called the day mefloquine was dispensed “Psycho Tuesday.” In a field report written on October 26, 1993, in response to the killing of some Somali teenagers by Canadian soldiers, Major Barry Armstrong said, “Mefloquine may have impaired the conduct of Canadian and American soldiers in African postings and may (provide) a simple explanation of our difficulties in Somalia.

Lariam has even been cited as a probable cause in military mistakes in Afghanistan, including friendly fire.

No less an authority than the WHO (World Health Organization) recently removed Lariam from the list of recommended antimalarial drugs for duty troops visiting high-risk areas. Which poses the question: If Lariam is unsuitable for soldiers, why is it routinely doled out to civilians going to Sub-Saharan Africa, Southeast Asia, and South America?

With so much damaging evidence out there of side effects which may last lifetimes, La-Roche stopped marketing Lariam in the U.S. in 2009, but generic “mefloquine hydrochloride” is still widely available. And yet finally in 2013, the FDA issued a “black box” warning—a little too little, a little too late. In a recent article in The New York Times, Dr. Remington Nevin, a U.S. Army major and epidemiologist, commented, “Mefloquine is a Zombie drug. It’s dangerous, and it should have been killed off years ago. . . .”