The Ministry of Defence has said it is working with the NHS to ensure clinicians are aware of the potential side effects associated with mefloquine, following a parliamentary question on veteran mental health and suicide risk, the department stated.
The issue was raised by Sir Julian Lewis, Conservative MP for New Forest East, who asked what steps had been taken with the Department of Health and Social Care to ensure NHS practitioners are informed about vulnerability to suicidal ideation among veterans affected by the anti-malarial drug, also known as Lariam.
Responding for the government, Parliamentary Under-Secretary of State Louise Sandher-Jones said mefloquine remains recommended by international health bodies, including the World Health Organisation, and that both the MOD and NHS follow National Institute for Health and Care Excellence guidance on its prescription and management. She said the MOD is engaged with NHS England through the Armed Forces Clinical Reference Group, which has recently reviewed how side effects linked to mefloquine are clinically managed.
“As symptoms can resemble acute psychiatric conditions, clinicians are advised to assess patients individually and are expected to take a full drug and alcohol history, including any previous mefloquine use,” she said.
The minister added that veterans in England can access specialist support through Op COURAGE and Op RESTORE, with comparable services available in Scotland, Wales and Northern Ireland. These programmes provide mental health, physical health and wellbeing care tailored to former service personnel. Sandher-Jones encouraged veterans experiencing mental health difficulties to seek support through their GP or by self-referring to Op COURAGE.
“The side effects that may be experienced whilst taking, or with a history of having taken mefloquine, will be treated according to the diagnosis,” she said, adding that appropriate clinical pathways would be followed based on individual symptoms.
The easy answer is yes, I don’t know an urgent or emergency care work who is not aware of the nastiness of anti Antimalarial drugs…even the common side effects are unpleasant. It’s sort of like asking the question “are car drivers aware of the brake pedal ?”
Nobody is suggesting clinicians are unaware that antimalarial drugs can have unpleasant side effects. That is well understood.
The concern is much narrower and more serious: whether historic exposure to mefloquine in particular is consistently recognised as a possible contributor to long-term neuropsychiatric symptoms, sometimes years later, and sometimes misdiagnosed as PTSD or primary mental illness.
There are clear precedents in NHS history. Gulf War illness (syndrome) was for years misattributed to stress or mental health conditions before patterns were formally recognised. Reports emerged soon after the conflict, and it took years of advocacy, research and assessment programmes before serious attention was paid to them by government and healthcare systems. Noise-induced hearing loss and asbestos exposure in service personnel were also initially treated as routine or lifestyle issues, with the service link accepted only much later. In each case the issue was not clinician competence, but delayed recognition of how historic exposure could drive long-term symptoms.
Hi Greg the thing is this is a ubiquitous drug.. it not specific to the military.. lots of people travelled and took it.. so it’s very very well known….its not gulf war syndrome or another very specific military issue ( like combat related PTSD)
And in reality historical usage is functionally irrelevant.. it does not make a blind bit of difference if your mental health condition was caused by a drug you took a decade ago or not… because there is zero you can do about a drug that was taken a decade ago it and it would change zero with how you treat the person..
The only time it matters is if the person is taking the drug now or has only just taken it…
It’s just a bit pointless.. the key question is around good mental health services for veterans… because cause is far far less relevant in mental health than dealing with it today.
I will try to use an analogy.. Cocaine can cause massive cardiac issues short and long term.. if someone is having a heart attack now knowing the have Cocaine in their system is necessary.. and if a younger person has a heart attack we always check that… but some who has suffered heart failure from the effects of taking Cocaine a decade ago.. we treat the heart disease but knowing or not knowing they took cocaine a decade ago is functional irrelevant and no clinician ever ask the question ohh you have heart failure.. ever taken cocaine?
Larium at the time was the most effective anti-malarial that you could get. I had to use it twice, both for trips to Africa. I can confirm that it affected me, to such an extent, my wife moved out of the house for two weeks prior to me going away. The worst thing is that I still have no recollection of how nasty or aggressive I became. She said that on both occasions of taking Larium I acted the same (A***hole was mentioned a lot!), but those two weeks when you’re building up your body’s ability to defend itself against malaria. Nothing, not even a blur of what happened in those two weeks. It’s like I remember getting the brief in the med centre, opening the bottle and then I’m at Brize or Lyneham waiting to get on a plane. Literally anything could have happened in those two weeks prior to going and I still to this day can’t recollect what happened during those weeks!
But what was weird is that everyone who took it, had different side affects. With some, it was like taking a placebo and they acted and felt normal. Whilst others had severe nightmares and panic attacks. A lot did have memory lapses the same as me. I know one of my friends became super aggressive, to such an extent he was locked up, as he caused a fight a put a number of people in hospital. He was properly nicked by the Police, but got away with it due to the Chief Surgeon writing a letter. So the side affects were known my the medical services.