In recent years, more veterans have reported PTSD-related symptoms such as depression and suicidal thoughts without serving in war zones, civilian experts confirm. Many of those veterans were required to take anti-malarial drugs, leading the Department of Veterans Affairs to support a study released today by the National Academies of Sciences, Engineering, and Medicine that found a possible relationship between the drugs and the symptoms.
The study conclusions were released during a presentation in Washington at NASEM headquarters.
“We take this question seriously that it has plausibility,” said Dr. David Savitz, professor of epidemiology at Brown University and chair of the yearlong study that considered more than 12,000 abstracts of prior research involving thousands of veterans, Peace Corps volunteers, and others who used anti-malarial drugs.
“The exposure of concern here is when troops are deployed or anyone is sent to a country where there is endemic malaria,” he told the Washington Examiner on Monday, referring to areas of Asia, Africa, and the Middle East where troops are stationed.
Malaria is a mosquito-borne parasite and life-threatening disease found in tropical and subtropical climates.
A variety of symptoms while taking anti-malarial drugs are common, but the troops in question say their symptoms persist long after they stopped taking the drugs.
The VA spent $1.28 million on the study “Assessment of long-term health effects of antimalarial drugs when used for prophylaxis,” which was conducted by NASEM.
The academies noted that in 2018, there were 228 million cases of malaria worldwide, 405,000 of which resulted in death. Members of the military have been affected by malaria since the Civil War — it remains an ongoing threat in many parts of the world where U.S. service members are deployed.
While U.S. troops have taken anti-malarial drugs for decades, two of the drugs evaluated have only come into use in recent years.
In 2009, troops serving in zones where malaria exists were required to take the drug mefloquine, which has been associated with psychiatric and neurological side effects. Since December 2019, the drug tafenoquine has also been used and has shown fewer side effects, Savitz said.
Some of the post-traumatic stress disorder symptoms reported include anxiety, depression, and ringing in the ears.
During a brief question-and-answer period during Tuesday’s presentation, a doctor representing American veterans and a Canadian veteran said international drug regulators and the FDA have put warning labels on mefloquine. They called on the VA to take a stronger stance about the relationship veterans say is real.
“I was a fit soldier,” said retired Chief Warrant Officer Mary Demetruk of the Canadian Armed Forces. “We do suffer from mefloquine.”
The veteran, who served for 38 years before retiring, said she suffered foot blisters after leaving Somalia. After her return, she had two miscarriages and began to suffer from forgetfulness, stomach problems, persistent cough, and chest pain.
“I can’t catch my breath. What’s doing that?” she asked the researchers.
Dr. Remington Nevin of the Quinism Foundation, the first to take the Q&A podium, said he represented American veterans and asserted that international drug regulators acknowledge that permanent neurological and psychological effects are possible.
“Our group and the veterans we represent are going to be disappointed,” he said of the study’s conclusions.
The VA said in a statement that it appreciated and is now evaluating the study, but a spokeswoman specifically discredited any association between veterans who took anti-malarial drugs and the symptoms reported.
“After a full evaluation and diagnosis, VA has found that most symptoms are unrelated to antimalarials,” VA spokeswoman Christina Mandreucci wrote in an email response to questions, noting that another VA study is underway.
The VA did not respond to a question about the number of veterans who claim a relationship between PTSD-like symptoms and taking anti-malarial drugs.
In its presentation of the conclusions today at NASEM’s building in Washington, Savitz emphasized the “inadequate or insufficient” empirical evidence and noted that a review of the studies suggests that further research is necessary.
The committee said that of the thousands of studies on anti-malarial drugs, only 21 specifically looked at the long-term health effects, making it hard to draw conclusions.
The lead researcher acknowledged that the lack of definitive conclusions may not provide solace for some sufferers but noted that the study is a starting point to recognize a problem that needs more attention.
In evaluating the research, the committee did not conduct new studies but rather reviewed information from U.S. and foreign governments and received briefings from the VA, the Department of Defense, and the Food and Drug Administration.
In its oral research, Savitz said today the committee heard from veterans about the “debilitating problems” they suffer.
Savitz said the risk of acquiring malaria “outweighs whatever uncertainty or side effect may be associated with the medication.”
That means troops would be worse off if they did not take the medication.
Recommendations for future studies include supporting a variety of new investigations that zero in on possible side effects after the drug regimen has ended.
“There may be ways to extend the kind of drug trials,” he said of current studies of new drugs. “They tend to end at the point where they stopped taking the drug, and they don’t simply extend the follow-up to ask what happens after, and that would add to the knowledge.”
Future proposed studies may include research on animal models and the use of DOD and VA databases.
“There is a critical need for well-designed studies to answer important safety questions,” Savitz concluded.
