Bad Trip

Could the antimalaria drug Lariam be as risky for you as the disease it's made to treat? And why are we still taking it?

IN MAY 1992, I was 19,000 feet up an unclimbed mountain called Ratangrian, in the Indian Himalayas. My two teammates and I were scaling a snowy ridge less than 300 feet from the summit when the panic hit me—not fear of falling but an alien sort of terror that I'd never felt before. "We need to get off this mountain!" I shouted. They thought I'd lost my nerve from the exposure. "We're going down, now!" I commanded. We descended, but I'd blown our dreams of a first ascent.

Back home in Colorado, fear and fatigue crippled me. I also became inexplicably fixated on the idea of killing myself and fought dark visions of ending my life, uncharacteristic of my otherwise upbeat personality. None of the doctors I visited could tell me what was wrong. My symptoms went on for six years, and then, between 1998 and 2000, the problems gradually abated. I've since climbed in the Himalayas three times, but the mystery of the whole episode lingered until last January.

That's when I stumbled across a 2002 news story about four murders allegedly committed by soldiers at Fort Bragg, North Carolina—two of whom subsequently killed themselves. It was speculated at the time that three of the four had been taking the antimalaria drug Lariam. (An Army investigation later ruled out any link, but the media attention ignited the first widespread scrutiny of the drug.) I'd taken Lariam in India. Back then, I hadn't read the list of possible side effects published by Roche—the pharmaceutical company that makes Lariam—which indicated various maladies but said nothing about suicide. Reading the product information recently, I found a laundry list of what had ailed me: dizziness, severe anxiety, paranoia, disorientation, hallucinations, bad dreams, difficulty sleeping, depression, and suicidal thoughts. Though I was never able to get a medical diagnosis, I was sure I'd found my answer.

The more I looked into it, the more I discovered that I wasn't the only one worried about Lariam. There's a small-but-vocal camp, including Lariam Action USA (run by attorney Sue Rose), who believe the drug is dangerous. On the other hand, advocates note that it's among the best tools for fighting one of the world's deadliest diseases. The FDA's position is that "Lariam is a valuable drug in helping to prevent malaria, but in rare instances it has been associated with serious psychiatric adverse events." A Roche representative I contacted added: "The labeling for Lariam has been revised over time, in dialogue with the appropriate regulatory bodies, to reflect current medical and scientific knowledge."

Mefloquine hydrochloride was developed at the Walter Reed Army Institute of Research after the Vietnam War. It's been marketed in the U.S. as Lariam since 1989 and has been taken by more than 25 million people. Early reports of adverse physical and psychiatric side effects prompted the World Health Organization to issue a 1991 review that cited "severe and alarming" psychiatric events, but estimated the rate of incidence at one in 10,000.

In 1996, researchers at the UK-based Medical Advisory Services for Travellers Abroad, a national network of travel clinics, reported that one in 140 would experience side effects severe enough to interfere with daily activity and that 40 percent would experience some adverse effects. In 2003, a study in the British Medical Journal noted moderate to severe neuropsychological effects in 37 percent of participants. In late 2002, Roche had added a suicide disclaimer to its "Lariam Medication Guide," which is approved and published by the FDA.

The problem is that many of those possibly affected—myself included—simply think they've gone nuts. Cases like mine often go unreported, but even when they surface, there's no medical proof that Lariam is to blame. Previous reports were based on surveys of large numbers of patients. There has been no clinically proven link between Lariam and mental illness in humans. In 2006, a study at Walter Reed showed that the drug causes degeneration in the brain stems of rats.

As they say in pharmaceutical commercials, consult your doctor. There are other antimalaria drugs, but there are reasons, including dosage frequency, why doctors choose one over another. Most physicians don't have the same fear of Lariam that I do, and many still readily prescribe it. Dr. Stephen Hoffman, the CEO of Sanaria, a small biotech company in Maryland that's working on a malaria vaccine, is one of them. "I still give Lariam to my children," says Hoffman, who has worked with the drug since 1981 and witnessed malaria's devastation and Lariam's remarkable effectiveness against it. "The side effects are predictable and relatively uncommon. All drugs come with risks. You have to weigh the side effects against the chances of getting malaria."

If only I'd known back in 1992 what I know today.

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