Mefloquine depression with

While its detailed mechanism of action is unknown, it is an effective blood schizonticide that is, it acts against the form of the parasite responsible for chnical symptoms. Orally administered mefloquine is well absorbed and has an absorption half-hfe of about 2 hours the elimination half-hfe is 2 to 3 weeks. Among its side effects are vertigo, visual alterations, vomiting, and such CNS disturbances as psychosis, hallucinations, confusion, anxiety, and depression. It should not be used concurrently with compounds known to alter cardiac conduction or prophylactically in patients operating dangerous machinery. It should not used to treat severe malaria, as there is no intravenous formulation. 

The latter adverse effects are more common with the higher dosages required for treatment. These effects may be lessened by administering the drug in two doses separated by 6-8 hours. The incidence of neuropsychiatric symptoms appears to be about ten times more common than with chemoprophylactic dosing, with widely varying frequencies of up to about 50% being reported. Serious neuropsychiatric toxicities (depression, confusion, acute psychosis, or seizures) have been reported in less than one in 1000 treatments, but some authorities believe that these toxicities are actually more common. Mefloquine can also alter cardiac conduction, and arrhythmias and bradycardia have been reported. 

A 52-year-old woman with no psychiatric history developed anxiety, paranoia, visual hallucinations, confusion, and depressive symptoms after 3 doses of prophylactic mefloquine (250 mg/week) (502). She had previously taken mefloquine prophylaxis intermittently for 4 years with no adverse events. 

A 48-year-old woman developed anxiety, tremor, depression, dry mouth, nausea, and marked weight loss (503). Physical examination, electrocardiography, chest X-ray, CT scan, and laboratory investigations were unremarkable. The Hamilton D score was 44 for 17 items. She had taken mefloquine 250 mg/week for 8 weeks for malaria prophylaxis, and after 2 weeks had started to feel unwell, with dysphoria, depression, and weakness. She was given fluoxetine 20 mg/day and alprazolam 1.5 mg/day. Her condition continued to deteriorate. The dose of fluoxetine was increased to 40 mg/day and flunitrazepam was added. She was later instead given milnacipran, a serotonin and noradrenaline reuptake... 

In another major review the risk of depression, psychosis, a panic attack, or a suicide attempt during current or previous use of mefloquine was compared with the risk during the use of proguanil and/or chloroquine or doxy-cycline (513). The study population (n = 35 370) was aged 17-79 years (45% men). There was no evidence that the risk of depression was increased during or after the use of mefloquine, but psychoses and panic attacks were more frequent in current users of mefloquine than in those using other antimalarial drugs. 

Tranylcypromine is a chiral monoamine oxidase inhibitor used in the treatment of depression. The drug is similar to mefloquine in that it is contains a diastereomeric structure but is only administered as the 50 50 combination of the (- -)-lS,2R and (—)-lR,2S species. The enantiomers possess differences in their pharmacological properties in that (-I-) tranylcypromine is much more effective than its antipode in MAO inhibition, but the (—) enantiomer causes greater diminution of catecholamine reuptake and release than (-I-) enantiomer [147]. With respect to its pharmacokinetics (Table 1), the (-I-) enantiomer seemed to be cleared via the oral route 4 to 8 times more rapidly than antipode based on significantly... 

Mefloquine does not normally appear to interact with alcohol, although excessive alcohol may possibly contribute to its adverse effects on the liver. An isolated report describes two incidents of severe psychosis and depression in a man taking mefloquine who drank large quantities of alcohol. 

Mefloquine (also known as Lariam) came on the scene in the 1960s, and was widely used by American troops during the Vietnam War to treat chloroquine-resistant strains of P. falciparum malaria. Resistance to mefloquine, too, has developed over the years, and it remains controversial, with claims for rare but unpleasant side effects, including depression, mood disorders and permanent personality changes. 

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