Lariam’s Psychotic Side Effects?
CBSNEWS.COM, 60 Minutes II,
Jan. 29, 2003
Last summer, four soldiers from Ft. Bragg were accused of killing their wives. Two of the men committed suicide, and the other two await trial. So many brutal crimes, so similar, so close in time – raised questions, and the army sent a team to investigate.
One possible suspect was mefloquine - brand name Lariam, an anti-malarial drug. It was invented by the U.S. Army and is routinely given to soldiers deployed overseas. In scientific terms, Lariam can cause neuropsychiatric adverse events. In plain language, it can make you crazy. No one questions Lariam’s effectiveness in preventing the deadly disease of malaria. Millions of tourists and other world travelers take it every year with no problem.
But a significant number of people have seen and felt first hand its devastating side effects. Vicki Mabrey reports.
It was supposed to be a dream vacation, a safari to Kenya last September for Dr. Robert Daehler and his wife Jane, seen here on home video. What you won’t you see is how, deep in the African bush, she suddenly transformed before his eyes.
“She just became completely psychotic in the van,” says Bob. “(She”) started taking her clothes off and she had called people back from the dead. And they had a doctor at this lodge that came into the van. And she looked at Jane and she said, ‘Did she take Lariam?’ She said she had seen this in many Americans.”
So had three other doctors in Africa, who confirmed the diagnosis. Jane Daehler was flown home, strapped to her seat with a bedsheet. At home, she spent a month in a psychiatric hospital, in and out of psychosis, with terrifying hallucinations. At the U.S. hospital, she was diagnosed with Lariam-induced psychosis.
“They were just horrific. I thought that people were trying to kill me all the time. I thought that my family was going to be killed,” says Jane.
According to its own internal documents, Roche pharmaceuticals, Lariam’s maker, has received over 3,000 reports of psychiatric problems associated with the drug, from nightmares, depression and hallucinations to paranoia, psychosis and aggression.
But could Lariam lead to something worse? That was the question raised last summer when this man, Master Sgt. William Wright and three other Ft. Bragg soldiers were accused of killing their wives, all within a period of just under six weeks. Wright and another soldier were given Lariam, and Wright is considering using that as part of his defense. One of his fellow Green Berets thinks Lariam did play a role. John Lown, now an ordained minister, visits Wright in jail every week.
At first, Lown says, Wright was “very confused, he was very paranoid, and I was like ‘Wow this is not the Bill that I knew.’… About the fifth week after that, he was, he was coherent. He was fine. He even said, ‘Well, I’m thinking a lot better now.’”
What does Lown think caused his change? “I think it was the medication. It took about two months for the stuff to clear out of your system.”
Lown and his unit had names for the days they took Lariam: “Everybody would call it manic Mondays or wild Wednesdays.”
His wife, Debbie, says she’d see an immediate change when he was on Lariam: “He just turned ugly towards me… And when I mentioned that to other wives, they said that’s the way their husbands are as well.”
The other wives told her that while on Lariam, their husbands “were very negative, aggressive. Couple of them even complained how they’d be woke up in the middle of the night, shook, be called names. One running down the street without his clothes on, hollering, screaming.”
How do she know it just wasn’t the stress of the job? “He’s been on other deployments where Lariam was not required and he didn’t have these kind of problems,” says Debbie.
Like her husband, Debbie Lown is convinced Lariam was a factor in some of the Ft. Bragg murders. She had even complained to military authorities as far back as 1996.
“I said, ‘I’m not asking you to stop giving them the Lariam. I’m just asking you to better inform the soldiers of what they’re taking, tell their wives, because they’ll save marriages that way, they’ll save lives that way,’” she recalls.
Jane Daehler agrees that knowing it was the Lariam can make all the difference. “If it wasn’t for (my husband), I honestly think that somebody could have put me in a mental institution and thrown away the key.”
Before the trip, her husband, a physician, says he was careful, since his wife had been treated for depression in the past and was on what he says was a low, preventative dose of Prozac. He checked with a travel clinic, the Centers for Disease Control website, and his physicians drug guide.
The information was written by drug companies for doctors and approved by the Food and Drug Administration. The key part is the warning section: “Lariam should not be prescribed in patients with active depression or with a history of psychosis or convulsions.”
“That’s what I read,” says Bob. “And Jane did not have active depression. She did not, it was 10 years earlier. She did not have psychosis ever. She never had seizures…. Nor did I. There was no reason why either of us couldn’t take this drug.”
But what was not in the warning section, what may have raised a red flag for the Daehlers are these disturbing side effects, depression, hallucinations, psychotic or paranoid reactions, aggression, all listed towards the end.
“They buried the lead. They took the important information that would’ve tipped off a doctor, and stuck it down there in a part that’s not part of the warnings,” says attorney Bernard Fischman, who represents the Daehlers in a lawsuit they’ve filed against Roche. Fischman argues that the company failed to properly warn them.
Can’t Roche argue, that the information is there? “It doesn’t call any attention to the real nature of this problem. There’s no mention of psychiatric problems under the warning section of that package insert,” says lawyer Paul Smith, who is also representing the Daehlers.
“There’s alternatives that can be taken, there’s just no reason that americans should be taking Lariam,” says Bob Daehler.
Doxycycline, a common antibiotic, and malarone, approved two years ago, are both effective in preventing malaria and have fewer psychiatric side effects than Lariam.
Roche, the drug company, claims that Lariam causes serious psychiatric side effects in only one in 10,000 people. But Dr. Paul Clarke, an infectious disease specialist and the medical director of a large network of travel clinics in Great Britain, organized his own study, after he and other British doctors saw problems with much greater frequency.
“It was confusion, it was disorientation, it was anxiety and panic attacks,” says Clarke. “There were episodes in which people were clearly divorced from reality and indeed had unusual symptoms that could be described as psychotic.”
Their research confirmed the hunch. Not one in 10,000, but closer to one in a 140 suffered disabling side effects, defined as substantially disrupting their lives - the same kinds of side effects that Dr. Clarke had seen in his patients.
Why such a huge difference in the numbers? Because of the key difference between the term “disabling” in Dr. Clarke’s study and the term “serious” as used by the drug company. In Roche’s study, serious meant you had to be dead, in the hospital or have a long-term disability to count. It’s an industry standard all drug companies use, but with that narrow definition, Dr. Clarke says, Roche’s study may have failed to identify up to seventy times more patients with troubling side effects.
Based in part on Dr. Clarke’s study, British authorities began to recommend using Lariam less often. Despite his concerns, though, he still says Lariam can be a useful drug.
“It’s very easy to take once a week, it gives you very good protection, you get good compliance. And if you’ve taken it in the past and never had a problem with it I, for one, would be very sorry to see it go, because it’s a good drug,” he says. He only wants people to be better informed.
60 Minutes II ask both the FDA and the CDC about how well the American public is informed of Lariam’s potential dangers. But both government agencies chose not to do an interview. The FDA did send a statement, saying that Lariam’s benefits far outweigh its risks.
Roche also declined a request for an interview, but sent a statement saying, in part, that no prescription drug is free of side effects.
Roche also said there’s no way for a physician to predict every person at risk for psychiatric side effects. Linda Perry considers her husband a perfect example of that.
In 1998, Linda and Chuck Perry left their Midwest ranch and their seven children to go on an African safari for their 30th wedding anniversary. Linda, a registered nurse, checked with her doctor, her pharmacist, and the local health department. For malaria protection, they all recommended Lariam.
“The first warning I ever got was from the safari guide in Africa,” says Linda. “She says to me, ‘Well, why do you take Lariam?’ It’s a hallucinogen very much like LSD.’ And I said, ‘the CDC recommends it.’ And she said, ‘Well, we never take it.’”
After four doses of Lariam, the Perrys were having night sweats and vivid nightmares. But everyone, including the CDC, had stressed taking the full dose of the drug, which meant taking it for four weeks after the trip. That’s when Chuck Perry’s real problems began.
Perry: Didn’t know where he was. I mean, he ran out in the yard. I can remember tackling him in the yard saying, “what are you doing? What are you doing?” you know. “the neighbors are after me, somebody’s after me.” And it was just bizarre, just– just bizarre.
mabrey: You had never seen anything like this from him before?
Linda Perry: Nothing. He’s the rock of the earth, salt of the earth.
Linda Perry says her husband had no prior history of depression or mental illness. Chuck Perry was hospitalized and tested repeatedly. A team of doctors became convinced that Lariam was responsible. Linda says that the doctors didn’t know how to help him.
Six months after returning home from Africa, Chuck Perry committed suicide.
“We had no way to know that this drug would be so powerful that it could alter his personality so much and damage him so much that he would, in fact, do that in some type of delusion or hallucination. That’s what we didn’t know,” says Linda Perry.
But Roche did know something about Lariam and suicide. Over the past year, two UPI reporters, Dan Olmsted and Mark Benjamin, unearthed these internal documents. They show that by the time Chuck Perry killed himself, the company knew of at least seven suicides, and 13 suicide attempts, by people living outside the United States - all associated with Lariam. But nowhere in its product information was there any mention of the word suicide.
After two years of trying to attribute Chuck Perry’s suicide to other causes, Roche settled a wrongful death suit with Linda Perry last May.
Two months later, Roche dramatically changed its product information. Psychiatric side effects are now in the warning section, including, for the first time, rare cases of suicide.
But Roche says there is no proof linking its drug to suicide, and points out that Chuck Perry is the only reported American suicide of the more than five million who have taken Lariam in the U.S. that doesn’t address the other suicide reports outside the united states, but Roche says those cases are well below the suicide rate in the general population. When we requested current figures, Roche declined, saying that accurate numbers on all reported events are hard to come by.
Dr. Paul Clarke: What is not clear is, how many people may have been permanently damaged, if any, or indeed may have gone as far as a psychotic episode, which might’ve led to some other ghastly accident.
But could it have led to murder at Ft. Bragg? In early November, the army released its findings, which said that Lariam, in the army’s words, does not explain the clustering of violent deaths there. As a result, the military probably won’t change its policy on Lariam’s use.
Should it be given to soldiers with guns? Says Clarke: “I would not give it to them. Because we do have alternatives and we do know they’re effective.”
Unlike the U.S., Great Britain, Germany and Australia did not give their soldiers Lariam in Afghanistan, opting instead for those alternatives. But as the United States prepares for the possibility of war with Iraq, some of our American troops are already being given Lariam.
“I saw his truck in the driveway but I couldn’t find him,” says Lifka, “then I went outside and looked over my deck and saw him laying there in the snow. Through his jeans I could see the bulges of muscle on both sides of his legs; they had completely separated from his knee cap. By the time the ambulance came, his water bottle was frozen.
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The truth is that many people would probably not consider tendon rupture to be a side effect of medication—especially medication for something as simple as an infection. But Levaquin has reportedly been linked to an increased risk of tendon ruptures. These ruptures are incredibly painful and can have a major impact on a person’s day-to-day life.
