Since the start of January, I have had incredibly vivid dreams. I can’t remember the last time I slept through the night soundly, and it’s beginning to get unpleasant. At first I thought it was stress-related, because I’ve been significantly more stressed and busy this term than I have in a long time. But my sleep patterns have been so consistently poor that I’m beginning to think that stress is not the only underlying reason.
Let’s rewind a bit. From June 2007 to June 2008, I was on Mefloquine, an anti-malaria drug taken weekly. I wasn’t in areas with malaria that whole time, but the Mefloquine prescription starts one week before you’re in a malaria zone and lasts for four weeks after. I traveled so much during that year that I was on Mefloquine continuously.
Mefloquine is notorious for giving people vivid dreams. Add that to the list of other side effects, and it’s a pretty scary drug. (“Mefloquine may have severe and permanent adverse side effects.” Fantastic.) To top it off, apparently it’s not uncommon for people who have taken Mefloquine in the past to continue experiencing side effects long after they’ve stopped taking it (does almost 3 years count?), especially during period of high stress.
Mefloquine is probably one of the worst malaria prophylaxes, but it’s one of the more common because it’s cheap and weekly (as opposed to expensive and daily). Other options such as Malarone have a better reputation, but they’re all still rather powerful drugs.
So in June 2008, I stopped taking malaria prophylaxis altogether. Here’s why:
1. Malaria prophylaxes are powerful, and I don’t want them in my body. Especially for long period of time. I don’t like taking regular pain killers, and the thought of putting something significantly more powerful in my body scares me. Also, would you want to take a drug that gives you side effects years after you’ve stopped taking it?
2. Malaria prophylaxes don’t always work. Certain prophylaxis only protect against certain strains of malaria, and there’s no guarantee that’s the one you’re going to get. I have a friend who spent a few months in Africa on two separate occasions, took prophylaxis both times, and got malaria, both times.
3. Malaria tests and treatments are easy to come by and more trustworthy in Africa. If there’s one test that every clinic has the ability to do, it’s a malaria test. Ok, there are probably some rural and poorly stocked clinics that are currently out of the supplies, but in general this is one of the most common diseases that clinics deal with. Both the test and the treatment are also cheaper in Africa (there’s a higher demand for them), and frankly I trust them more. Western doctors probably see very few malaria patients, and so no matter how much experience they have in medicine, they are less likely to be as familiar with malaria.
So I sleep under a mosquito net, I get myself tested if I feel sick, and I carry a treatment (just in case I’m somewhere without access to a treatment). Now I just need to get rid of the side effects from my year on Mefloquine back in ’07 – ’08.
February 11, 2011 at 3:21 pm
So I’m generally in favor of living without malaria meds (I haven’t taken malaria prophylaxis in 15 months, living in Africa for 12.5 months during that time), however I think that there are circumstances where the risks of the prophylaxes outweigh the risks of having malaria. For example if you’re traveling for 3 weeks or so and need to get a lot of work done in a short space, you probably don’t have time for malaria to slow you down (and you are probably going to have a more severe reaction to the bug since your body is adjusting to a new climate).
I’d say that for trips over 2 months, it’s really not worth it, but for shorter trips, it’s more of a judgment call. Each of the prophylaxes has its associated downsides, but in that case, I think malaria has the greatest downside…
February 11, 2011 at 4:29 pm
and don’t forget your brother almost died from taking an anti-malarial!!
February 12, 2011 at 8:08 pm
Yea! I did. That sucked.
February 11, 2011 at 5:18 pm
I took Mefloquine for a year as well and still got Malaria. The one difference was that the case was pretty mild and the doctor credited the Mefloquine. Not sure if it is exactly why, but compared to friends who got Malaria while off prophylaxis, I had a cake-walk.
However, I think you make some good points and you under-stress two things. First, get tested when sick. Second, have Malaria medication on hand. In my opinion, that is excellent advice that you give.
Stay healthy!
February 11, 2011 at 6:44 pm
For short-term travelers to malaria endemic areas, the cost of prophylaxing is less than the average cost of treatment, which is the rational behind the recommendation to prophylax. Also, the average traveler:
1) Can not identify malaria symptoms and thus has a greater probability of presenting late to care
2) Is not aware of medical resources or healthcare system structure in their country of travel
3) Does not have the same innate immunity as the native people to his/her country of travel (from lack of exposure to the disease and from lower likelihood of genetic protection)
For long term travelers (such as yourself), I think that prophylaxis loses it’s cost-effectiveness. I personally hate Mefloquine after having taken it for most of my life traveling to India from it’s hallucinatory side effects. Scary stuff. I think we should be more wary of prescribing it (especially for kids) and that adults should undergo some psychological screening before taking it. That is the actual recommendation, but I’m not sure that it happens very often. If you are looking for a different type of prophylaxis, I recommend Doxycycline, which has a much milder side effect profile and is generic so it’s cheaper and can be bought overseas.
I don’t mean with these comments to minimalize the serious burden of disease caused by malaria globally. It is responsible for 250 million cases and about 1 million deaths per year (mostly in young children and pregnant women), and, even in survivors of childhood disease, has been linked to long term mental deficits. I’d be interested to know if you have any thoughts about ways to reduce this disease burden in any of the places you have worked in?
Lastly, I agree that you will receive great care in the clinics you go to in Africa. But don’t knock Western docs yet! Even as as US student, I’ve seen and treated malaria. I think that if you were so unfortunate to get sick from malaria on your return trip from Africa, you should be confident that you’d get great care here as well : )
Safe travels and keep posting!
February 11, 2011 at 8:45 pm
I don’t mean to knock down all Western docs – I would trust you to treat my malaria, Aparna! But I do think that not all Western docs are going to have the experience or perspective that you have, simply because of your other interests. Just something to be aware of, that’s all.
February 14, 2011 at 11:31 am
What’s the old saying? An ounce of prevention is worth a pound of cure or something like that. In this case, I’d say it’s also true that an ounce of cure is worth a pound of prevention.
And to be honest, I’m pretty sure that both Jackie and I would’ve passed most psychological screenings and gotten a prescription for mefloquine regardless. I’d say they should determine a maximum length of time that a person could take the drug without experiencing long-term side effects and then instruct doctors not to prescribe it for longer periods (and maybe even include a warning label on the packages).
As for doxy, it doesn’t seem like the best thing to take an anti-biotic for a super-long time either. Personally, I have enough issues with the sun without the doxy side effects.
In terms of releasing the disease burden, one of the coolest proposals I’ve heard is in this article: http://www.economist.com/node/13437697
February 11, 2011 at 7:46 pm
I experienced some very serious mefloquine side effects during my time in the Peace Corps. Especially scary were the hallucinations (of people in my house and my hands being enormously swollen) that I experienced right after leaving training and living alone at my post in the bush.
Furthermore, I believe the anxiety that these hallucinations and the other strange sensations I experience caused a more deep-rooted anxiety to set in — anxiety that I had to be treated for for almost two years after leaving the PC (after two years of no theraputic treatment in the PC). This is despite the fact that I spent only 6 months on mefloquine — after my psychosis emerged, they moved me to doxy. Prior to entering PC, I had no mental health issues.
A neurologist and psychiatrist I saw a number of years ago suggested that mefloquine could have been the cause for all of this. And even if I was just a nutcase before taking it, I think this is a pretty scary and powerful drug!
What scares me even more is that some of our military serving in malaria areas also takes it… gun-carrying, depressed guys. Good idea, government!
February 12, 2011 at 6:49 pm
I very much agree with you, jackie. Especially if you’re one with an already vivid imagination things can go crrraaazy!
I took Malarone each time and had malaria each time pls a sprinkling of incredibly disturbing vivid nightmares…hamdulillah there’s no malaria in Morocco
btw, going to Senegal for a month in April, any chances you’ll head down that soon?
January 10, 2012 at 11:17 pm
I am so glad that i am not the only one who feels this way about this medication. i used mefloquine just once yes once (6 tablets) and i paid the price for one whole year!!! so i can imagine what some of you who used it for months must be going through. i had scary vivid dreams, the feeling of blacking out instead of falling asleep, extreme dizziness, panick attacks and as i worried more…the more i suffered. after many trips to different doctors..i was finally told by a concerned doctor that it was the medication. and heres something interesting that he noted:if you have anyone close to you (mum, dad, brothers ect..) that suffers from epilepsy (seizures) you should NEVER be prescribed this drug!!! my big brother is less than 2 years older than me and he is epileptic. the one good advise he gave me was to try and relax and dont stress as anxiety increases the unpleasantness. my issues started in october 2010 and only last year in late oct/nov 2012 did i started to feel normal. as someone who travels often to some african states with malaria i take extra precaution of covering myself with mosquito repellent, keep all my windows close and the air con on and i always wear thick long sleeve clothes. i have not have any issues.!!