There are many reasons to cry in the night. And one of them is a drug called Lariam. I’ve taken Lariam, a prophylactic against malaria (generic name mefloquine) a number of times. On each occasion I ignored the growing number of warnings about its disturbing side-effects – even though I’d mentioned them previously in this column. On trips to Asia and Africa I used the drug without any noticeable abreaction. My travelling companion on one of these trips was also taking it. He behaved a little strangely, but people behave strangely for all kinds of reasons, particularly when they are away from home.

So this time, when I woke up weeping in the early hours – though I had not done such a thing for a long time – I was still inclined to put it down to one of the usual suspects: loneliness, the loss of love, the death of friends, quarrels and betrayals, the tearfulness of everything. That is to say, not so much Lariam as lacrimae rerum. But when I stopped taking Lariam the crying stopped. By itself, this doesn’t prove anything. Travel is stressful; the psychoactive effects of drugs are notoriously variable; placebo effects are powerful. But many users of Lariam have had similar experiences. In some cases these were a good deal worse than mine: seizures, panic attacks, suicidal depression and a range of physical ailments. Some have taken years to recover. One died.

A group of nearly a thousand sufferers in this country have brought a claim for damages against Hoffmann-La Roche, the Swiss manufacturer of the drug (which was originally developed by the US army), one of many lawsuits around the world. And an increasing number of tropical medicine specialists are advising against the use of Lariam, at least as a prophylactic. It’s a nuisance, because malaria is getting worse too – more widespread and more resistant to existing drugs – and, as of the late 1990s, Lariam is the most effective prophylactic there is. More than a million people a year die from malaria, mostly in Africa. Statistically speaking, it is a far greater threat to health than Aids. In Europe the disease was thought to have been brought under control in the last century by draining swamps where mosquitoes breed, most famously in the case of the Pontine marshes outside Rome. But now the swamp thing is back: malaria is on the rise in Europe again. International air travel is responsible for this. There are ten times as many cases of malaria in Europe as there were five years ago – several thousand a year.

Malaria, delirium, lariam, lacrimae rerum

I’ve had malaria and it’s no fun. When I woke up in the night in Angola, feeling feverish and worried, I wondered if I had it again. Some of the thought disturbances induced by the comings and goings of malarial fever – rages and delusions – are similar to those reported by Lariam users. The brain goes into overdrive, then relapses. At first, during the attacks of melancholia I experienced while I was on Lariam I found myself obsessed by the name of the drug itself, an annoying near-anagram both of the disease it is supposed to prevent and of one of its symptoms: delirium. The words knotted themselves in my brain in a self-referential tangle: lariam, malaria, delirium. And lacrimae rerum. It was diverting for a while. Such intense, hyper-real aspects of brain fever have their uses – some writers and artists have gone to great lengths to induce them, pharmacologically or otherwise. But Lariam is nobody’s idea of a recreational drug.

Is it possible to know the ultimate cause of mental events of this kind? Or even the proximate causes? Hard to be certain. It is tempting to ascribe serious mood swings, along with all manner of afflictions and failings, to external causes. Illness exculpates us. It means it’s not our fault. And drugs, also, are easy to blame. If your state of mind is not the result of disease, then you may be inclined to think it is caused by its supposed cure. But it may indeed be. We should not be overly suspicious of ourselves. Even if we are constitutionally inclined to pin blame on something or someone else, this doesn’t necessarily mean there really is no such outside cause. In the case of Lariam, I can’t prove it, to myself or anyone else, but I feel pretty sure it had some part to play in my malaise that time in Angola.

In response to the bad publicity they’ve had, Roche have recently expanded the list of contraindications in the literature that accompanies packets of Lariam. If you’ve had any prior experience of ‘severe changes of mood’, they now say, you should not use the drug. So you can’t say they didn’t warn you. But ‘severe changes of mood’ are something most of humanity has experienced at one time or another. If these instructions are respected to the letter everyone will have to give up using the drug.

And that’s what I plan to do. I’ll take other prophylactics instead, marginally less effective and convenient, but also less anxiety-provoking. Or dispense with them altogether: sleep under a mosquito net impregnated with insect repellent, and hope to pass the night without waking or crying. ★

Afterword

I took to using a treated net in malarial areas – and no prophylaxis – until I got malaria again. After that I used doxycycline, a long-established antibiotic that doubles as a malaria prophylactic. Doxycycline is safer than Lariam and cheaper than Malarone (atovaquone/proguanil hydrochloride – now the favoured alternative to Lariam in most areas of the world). Malaria is still an unsolved problem, but thankfully there’s now a better treatment, Artemisinin, derived from a traditional Chinese herbal remedy, and used in combination with previously existing anti-malarial drugs.