By Nicholas Regush

On June 11, a special forces soldier at Fort Bragg, N.C. allegedly shot his wife and then killed himself. In July, three other soldiers at the base allegedly killed their wives. One of them also committed suicide after the death of his spouse.

Three of the men had served in Afghanistan. Is there a link between the ant-malarial drug, Lariam (mefloquine) and the violence? This is one of the questions that will be asked by an investigative team that will spend a week at Fort Bragg, which is home for the 18^th Airborne Corps and the Army Special Operations Command.

Soldiers are routinely given anti-malarial drugs when they are deployed to areas where malaria is endemic. Lariam is such a medication and was developed by the U.S. Army and was first used in the late 1970s. It remains the most widely used of the anti-malarial medications.

Whether or not the investigative team finds a link between Lariam and the killings, the issue has focused a spotlight on the drug, which has had a troubled past, including reports of many serious central nervous system side-effects, such as anxiety, depression, aggression, suicidal thinking, visual disturbances, hallucinations and confusion. For example, one randomized double-blind study of Lariam published last year in the Journal of Clinical and Infectious Diseases (33:1015-21) revealed that about one-third of non-immune Western travelers hoping to prevent a bout with malaria, suffered some form of central nervous system dysfunction, and that about 6 per cent of all users reported at least one serious side-effect. There is also evidence that side-effects can be long-lasting in some individuals.

The World Health Organization suggests that travelers with a family history of seizures or manic-depressive illness should avoid Lariam for malaria prevention. But that's apparently not an issue for American and Canadian public health authorities.

Lariam's manufacturer, Hoffman-La Roche, acknowledges central nervous system problems associated with the use of the drug, but has downplayed the extent to which it is linked to such serious side-effects as suicide and suicidal thinking.

What I find very disturbing is that after all these years of wide use of Lariam, very little is actually known about how the drug might cause either short-term or long-term effects. Considering that Lariam and other anti-malarials are used widely by soldiers, travelers and volunteers of all sorts to fight off malaria, you would think that federal regulatory agencies would have put some heat on manufacturers to better sort out who is most at risk for side-effects associated with anti-malarials (Alternatives to Lariam include doxycycline and Malarone).

In the case of Lariam, a team from the U.K. has recently published a thorough review of the literature in the journal, BioMed Central (2: 6) and has hypothesized that the side-effects associated with the drug may be linked to liver damage. And they also suggest that, "previous liver or thyroid disease, and concurrent insults to the liver (such as from alcohol, dehydration, an oral contraceptive pill, recreational drugs, and other liver-damaging drugs may be related to the development of severe or prolonged adverse reactions to mefloquine [Lariam]."

That's very intriguing and there should be studies to examine this hypothesis. In doing so, many lives might be saved.

As for the Fort Bragg situation, Í do not think there is a whole lot that the investigative team can come up with, given the poor understanding of how Lariam works on the body, and how it might trigger violence in some individuals. Unfortunately, this may make it easier for the Army to dismiss the theory that the drug is to blame for the deaths.