Mefloquine toxicity and Post Traumatic Stress Disorder have the same psychological symptoms. In this series, until now, we have been looking at war as the cause of Post Traumatic Stress Disorder. For clarity, let’s look at the clinical definition according to the DSM V –
“Diagnostic criteria for PTSD include a history of exposure to a traumatic event that meets specific stipulations and symptoms from each of four symptom clusters: intrusion, avoidance, negative alterations in cognitions and mood, and alterations in arousal and reactivity. The sixth criterion concerns duration of symptoms; the seventh assesses functioning; and, the eighth criterion clarifies symptoms as not attributable to a substance or co-occurring medical condition.”
The eighth criterion is actually the most telling when we examine PTSD. As I previously wrote, it is a physiological, biological condition that presents with psychological symptoms. By this definition, a strong argument can be made to remove PTSD from the DSM V. At the same time, because it presents as a psychological condition and the best treatment modalities are mental health therapies, there is also a valid argument for listing PTSD in the DSM V. In addition, PTSD while at root is physiological, untreated can develop into mental illnesses such as depression and acute anxiety. The spectrum of symptoms are then best described as a chronic condition.
However, not recognizing and treating PTSD as a biological condition, specifically of the central nervous system and/or a disease of the adrenal glands and limbic system, the standard pharmacopeia prescribed actually exacerbates the condition. For example, let’s look at this list of symptoms –
Loss of Reality
Here I have to issue a disclaimer. The above is not a list of PTS symptoms, it is a list of the side-effects of the most commonly prescribes drugs for the treatment of Post Traumatic Stress. To be clear, the above is not from the DSM V, it is from the warnings, side-effects and contraindications listed by the manufacturers of the very drugs prescribed to treat PTSD, by both military and civilian health care providers.
Here is another very telling list –
This is not a list of PTS symptoms either. These are among the more serious side-effects of a drug called mefloquine, the anti-malarial drug given to our troops. Worse, these side-effects can be long lasting and even permanent, according to new warnings issued by the FDA. They also state the neurological side effects of dizziness, loss of balance and tinnitus are even more common, and also may be permanent. They call this condition mefloquine toxicity and it can happen with the first dose.
This FDA warning was upgraded to what is known as a ‘black box warning’ in July of 2013. But this wasn’t news to the Department of Defense. In the first seven months of 2013, prior to the FDA ruling, the drug was given to just 2,417 of our troops; in 2009, the number was over 20,000. Even that number does not reflect the reality that this anti-malarial drug was until as recently as 2008, the most common malaria prophylactic administered to our troops.
The worst part is the military has known all along that certain drugs were never to be given to someone who had taken mefloquine. When a drug company says never to mix certain drugs, there are very good, well documented reasons. In this case, opiates, sleep aids, anti-anxiety and anti-depressants were all on the list of prohibited drugs for those who had received mefloquine.
Malaria is a problem that has plagued troops, and mankind, for millennia. In short, an infected mosquito bites, transmitting the parasite. Because the parasite has become resistant to most, and in some cases all antibiotics, treatment and prevention have focused on the symptoms. This is what mefloquine does – prevents the debilitating and often fatal symptoms.
The exact mechanism is not fully understood, but in layman’s terms, it acts like a buffer for the central nervous system, in theory, keeping the nervous system from succumbing to the effects of the parasite. Sometimes, the prevention or cure is worse than the disease. While it is possible to overcome malaria, there is no treatment for mefloquine toxicity.
If you are injured in battle, among the first medical treatments you receive will include opiates for the pain. Now you are recovering in a hospital and experiencing restlessness, anxiety and sleeplessness. So, you will be dosed with drugs to counteract those symptoms, each of which is also on the list of drugs never to be given concurrent or subsequent to mefloquine.
For these wounded warriors, they have received the trifecta of assaults on their nervous systems. First, they have experienced the trauma of battle. Then, they are injured. On top of these commonly recognized causes of PTS, they have also been chemically wounded, prophylactically and palliatively.
The story gets even darker when we understand just how this drug with such serious and known side-effects came to be the go-to anti-malarial drug of our military.
Soldiers fighting wars in places where malaria is widespread is a significant problem. Soldiers who were sick certainly weren’t capable of carrying out military objectives. Once upon a time, Quinine was hailed as the miracle drug.
It soon became apparent that for too many, the side effects of the drug were just as deadly as the disease it was meant to cure. Kidney damage was beyond medical science’s ability to effectively treat, so the drug was to be given as a cure for the afflicted, not as a preventative measure. Of course, that advice was routinely ignored by militaries around the world for many years.
Several derivatives of quinine were developed in the search for more effective treatments.But, Malaria was a deadly disease and life threatening side-effects alone were not sufficient reason to stop using something that worked. In addition, until medical science advanced enough to understand the mechanism of the disease, why something worked sometimes and didn’t work others was largely a mystery.
It is interesting to note that the ideas about drugs, parasites and even the human body were very primitive compared to today’s understandings. Yet, even today, there is still much unknown about the exact mechanism of quinine and it’s derivatives. For example, Quinidine is thought to work better than quinine because of someunknown interaction between the four derivatives of the chinchona tree, the source of quinine.
In the interim, ever stronger antibiotics were developed and used in the fight against malaria. But, because we are dealing with a living organism, the parasite evolved, eventually becoming resistant to each generation of antibiotics.
Eventually, the focus became prevention of the symptoms and prophylactics were developed. The aim was to be as effective as quinine but with less risk of liver, kidney and respiratory side effects. One of the most well-known of these latter day drugs is chloroquine. While liver and kidney side effects were less frequent, others became more prevalent. But these side effects were largely dismissed as they presented as emotional and mental issues, if those symptoms were even connected to the drug . This was the drug given to our troops during the Viet Nam era.
These new side-effects coincide with the rise of what was then termed battle fatigue or shell-shock. No studies have yet been done correlating the use of chloroquine and the ever-increasing problems reported by vets returning from ‘Nam. Yet, there was plenty of anecdotal evidence even at the time but those mental breakdowns, psychotic events, increased incidents of flash-backs, etc., the stereotypical problems of Viet Nam veterans were blamed on that generation of troops use of illegal drugs.
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