Travellers, doctors blame malaria drug for lasting psychiatric problems

Jessica Konecny took mefloquine when she went to Africa 12 years ago. She says she's been plagued by insomnia, anxiety and depression ever since.

Jessica Konecny says mefloquine triggered severe bouts of anxiety and depression.

Jessica Konecny with the box of Lariam (Mefloquine) pills she took while working in Ghana in 2004. (Amy Dodge, Windsor CBC)

When Chatham, Ont., resident Jessica Konecny travelled to Ghana for a university work term 12 years ago, she was prescribed mefloquine — sold then under the brand name Lariam — to help prevent her from contracting malaria, endemic in that region of Africa.

Almost immediately, she began experiencing vivid nightmares.

"I had a dream about a spider. I was sleeping in a bug net so when I woke up, the spider was huge and it was on my net and my roommate had to turn on the lights and physically take me out of the net for me to believe that it wasn't happening."

Konecny was 22 at the time.

She says she had never experienced psychological problems before going to Africa, but soon became depressed, anxious and suspicious.
Jessica Konecny was 22 years old when she travelled to Ghana in 2004. (Jessica Konecny)

"I became so paranoid that I thought everyone was talking about me, and I had to go to the doctor … right away he said, 'What are you on?' And I said, 'Lariam,' and he said, 'Get off of it.'"

Soldiers blame drug for psychological problems

Mefloquine had already come under scrutiny, with Canadian soldiers blaming the drug for psychological problems they experienced in Somalia in 1992-93. Others also reported having hallucinatory nightmares that felt like out-of-body experiences.

Konecny said the doctor who prescribed the drug for her did not tell her about any possible side effects. She chose mefloquine over other possible anti-malarial drugs because it was inexpensive and only needed to be taken once a week.

She stopped taking the pill after a two and a half months because of the psychological problems she experienced, but she says her mental health issues continued for the rest of her time in Ghana and after she returned to Canada. 

"So right away when I came back the biggest ones were anxiety and depression...and then with the depression I stayed in bed a lot...I started seeing a psychiatrist here in Windsor and I was treated for anxiety and depression and also added on a mood disorder. 

Travel doctor has heard complaints 

Travel medicine clinic doctor Peter Teitelbaum said over the years he's prescribed mefloquine for his clients in Ottawa. But more and more he now prescribes other anti-malaria medications.

It didn't take very long to become apparent to me that mefloquine sometimes caused problems for people.- Dr. Peter Teitelbaum, Riverside Travel Medicine Clinic

"It didn't take very long to become apparent to me that mefloquine sometimes caused problems for people … I certainly had people coming back for a second or third trip who said I don't want to take that pill again.

"A very common thing was vivid dreams or nightmares, that was the most common complaint I heard," he said. He also had reports of insomnia and, in rarer cases, depression and paranoia.

Earlier this year Health Canada updated its information on the drug, warning patients to avoid it if they have ever experienced seizures or any psychiatric issues.

According to Dr. Barbara Raymond, with the Public Health Agency of Canada, bad dreams, insomnia and sleep disturbances are not uncommon. But she said "anything more serious, psychological psychiatric effects are considered to be rare. Less than one in ten thousand people would experience such an occurrence."

Official rate of adverse reaction to drug called into question

Doctors and patients question that rate, saying serious issues are likely more common.
Dr. Peter Teitelbaum runs the Riverside Travel Medicine Clinic in Ottawa. He now rarely prescribes mefloquine for travellers heading abroad. (Steve Fischer)

Teitelbaum says Health Canada used a "passive reporting system," meaning the onus is on the doctor and patient to report any adverse effects.

He says without any system of registering or tracking patients, most people experiencing mental health issues will not take the time to file a report. ​

"It's not compulsory reporting and they're not going out and asking us," says Teitelbaum.

..more stories are starting to come in, of people saying..that could very much explain what is happening to me.- Cathay Wagantall, Conservative MP

No plans to take drug off shelves

It's estimated about 30,000 people are prescribed mefloquine each year in Canada, down from twice that many a year in the early 2000s.

Health Minister Jane Philpott says there are no plans to take the drug off the shelves in Canada, but that her ministry will continue to monitor its use.
Jessica Konecny in Ghana in 2004. (Jessica Konecny)

"The department makes decisions addressing the efficacy of this medication and all other medications on the basis of scientific knowledge and as new information comes to light, they bring that information forward," she said.

Ironically, Jessica Konecny contracted malaria, after going off mefloquine while she was still in Ghana.

She says she became terribly sick at the time, but quickly recovered.

Given a choice, she said she'd rather get malaria than deal with the after-effects of the drug.