As police in Madagascar investigate the horrific death of Cambridge University student Alana Cutland — who threw herself from a small plane as it flew above the island — there is growing concern that her death might have been the result of a psychotic episode caused by the anti-malaria tablets she was taking.
Sources have revealed that the 19-year-old, from Milton Keynes, Buckinghamshire, had been ‘staring into space’ in the hours before her death, after enduring sleepless nights and bouts of paranoia.
There is still some confusion over exactly what anti- malarial medication Alana was taking, although the authorities are investigating whether her erratic behaviour could have been caused by Lariam (mefloquine), which has repeatedly been linked with side-effects including psychosis and is one of the recommended malaria prophylaxes across Africa — including Madagascar.
19-year-old Alana Cutland, from Milton Keynes, Buckinghamshire, who threw herself out of a plane in Madagascar
So far, another antimalarial, doxycycline, has been confirmed among her possessions. Lariam has been linked in recent years with side-effects including anxiety, depression, hallucinations and suicidal thoughts.
In 2003, an inquest in Swansea heard that another Cambridge student, Vanessa Brunt, had returned from a gap-year trip in the Far East with a ‘haunted expression in her eyes’. She had taken Lariam, and committed suicide at the age of 22.
In the same year, there was a spike in suicides among U.S. troops deployed in Iraq who had taken Lariam. The Army played down the link as a ‘myth’, yet, the following year, when the drug was no longer prescribed to troops, the suicide rate plummeted.
Comedian Paul Merton has told of how, in the early Nineties, he took Lariam for a trip to Kenya and developed paranoia
Comedian Paul Merton has told of how, in the early Nineties, he took Lariam for a trip to Kenya and developed paranoia — he was admitted to a psychiatric hospital for six weeks as a result.
That overwhelming sensation of paranoia is something finance director Chris Elkington, 45, has experienced first-hand.
He was prescribed Lariam by his GP before a trip to South America in the early 2000s with his wife, Liz, a TV executive. ‘Liz and I both had to take one tablet a week for three weeks before leaving. After the first dose, we were both fine, if a little more jumpy than usual,’ says Chris, from London.
‘At one point, Liz dropped her keys and I nearly jumped a mile. Liz felt jittery — as if she’d had ten cups of coffee — but it was nothing she couldn’t cope with.
‘But, within four hours of taking the second tablet, I experienced a massive wave of paranoia. I was doubled over, convinced I had internal bleeding and was going to die. I was in turmoil, pacing up and down the flat, and felt very disorientated and erratic.
‘Liz and I weren’t married at the time and I called her at 2.30am and said I was going to die and needed to be with her. I drove frantically across the city and, when I arrived, she said I looked ‘unrecognisable’ from the usual calm person she’d seen earlier in the night.’
Chris Elkington, 45, (right) was prescribed Lariam by his GP before a trip to South America in the early 2000s with his wife, Liz, (left) a TV executive
Chris adds: ‘She checked me over and could see that there was nothing physically wrong with me. By this point, she’d realised that it must be the Lariam and, deep down I was aware of that, too. But I couldn’t shake the thought it was going to kill me.
‘I still wonder now what might have happened if Liz hadn’t been a reassuring presence. My mind was in a very dark place, and I don’t know what I’d have done if I’d been alone for much longer.’ The next morning, the couple visited the doctor to change their prescription, but Chris says that the experience has left a lasting impression on him.
‘If I’m quiet and on my own, I can still feel the same sense of foreboding I felt that night,’ he says. ‘I don’t sleep well because I’m convinced something is going to threaten the security of my family, and, if I need to focus on something, I need absolute quiet, as noises seem louder than normal.
‘I can pinpoint the change in me to the experience with Lariam. It’s something I’ll never forget.’
Hannah Maule-Ffinch, 42, a photographer from London, had a terrifying episode on Lariam
Hannah Maule-Ffinch, 42, a photographer from London, had a terrifying episode on Lariam, too. ‘In my 20s, I was heading to Venezuela and had to start taking Lariam a couple of weeks before,’ she says. ‘The GP had warned me I might have a few vivid dreams, and I started having them before I got to South America. But, when I got to the hotel in Venezuela, things became really intense. I was also having terrible nightmares and hallucinating.
‘When I looked around the room, it felt like the walls were melting. I thought I was taking care of a tiny baby who kept turning into a jelly-like substance — I was petrified.
‘At one point, I called downstairs to the hotel staff and made my way to reception, where I collapsed.
‘I woke up in hospital and was released a few hours later.
‘But that was it for me. I never took another Lariam tablet again. I met up with the group I was travelling into the Amazon jungle with and they were all having weird experiences on Lariam, too.
‘I remember two Belgian guys — who were best friends — punching each other’s faces to a pulp in a big fight, and they later blamed the Lariam. All but one of us in that group stopped taking the drug on that trip, despite the fact we were in the jungle.
‘I think that we all would have preferred to have had malaria than the awful side-effects of the drug. I can’t believe it’s still even on the market — it’s not safe at all.’
Georgia Lewis, 43, a managing editor for a publishing company, also had terrible dreams and a panic attack while taking Lariam.
‘I opted for Lariam on my first trip away to Nigeria with a new job in 2015,’ she says. ‘I got a four-week course and, after the first dose, I was fine. But, from the first day I landed in Nigeria, I permanently felt nauseous and had diarrhoea. When I arrived back in the UK, I still had two weeks of the course to take and went out with colleagues. I had one glass of red wine and felt instantly drunk. As I made my way to the loo, I freaked out, having a minor panic attack.
‘The dreams while on the drug were wild and erratic, too. I had to finish the course, but I’ve never touched Lariam since.’
Research suggests that Lariam can trigger psychiatric problems by disrupting the electrical signals between brain cells in the limbic system, an area of the brain that controls everything from long-term memory to sex drive.
Officially, the very severe side-effects are said to be rare, affecting around one in 10,000 users, and these adverse reactions occur more commonly in women.
Retired Lieutenant-Colonel Andrew Marriott, 64, took the drug for a year while posted to Sierra Leone in the early 2000s
When it was introduced 25 years ago, Lariam was hailed as a major breakthrough in the prevention of malaria. It works by killing the malaria-causing parasites while they are in our red blood cells and preventing them multiplying in the body. Some studies suggest it is up to 98 per cent effective at blocking the infection.
Yet critics say it should no longer be prescribed. MPs have demanded Lariam be considered ‘a drug of last resort’ for soldiers serving abroad, and the Civil Aviation Authority does not allow its use in pilots, in case it harms their mental health or performance.
The drug is either not used or is treated as a medication of last resort by the military in France, Germany, the U.S., Canada and Australia.
Johnny Mercer, a Conservative MP and former British Army captain, spoke out in 2015 to advocate an end to its use.
‘I’ve had a letter about once or twice a week,’ he said at the time, ‘from not only constituents but people all over the UK who have suffered or know someone who has suffered, they believe, as a result of taking Lariam.’
Meanwhile, the UK Lariam Veterans Facebook page says that it receives up to around 20 enquiries from concerned veterans each week.
Class-action lawsuits are now under way from Army veterans who claim they have suffered severe side-effects as a result of being prescribed the drug.
Retired Lieutenant-Colonel Andrew Marriott, 64, took the drug for a year while posted to Sierra Leone in the early 2000s.
‘I’ve not had an undisturbed night’s sleep since I started taking Lariam in December 2002,’ says Andrew, now an independent researcher, who lives with his wife in North Yorkshire.
Georgia Lewis, 43, a managing editor for a publishing company, also had terrible dreams and a panic attack while taking Lariam
‘I go to bed as late as possible, sleep for about an hour, have a very vivid dream or nightmare — some of which are absolutely horrific — and then wake up again. That pattern repeats itself over and over again.
‘Other effects have included occasional issues of anger management, when I can physically feel anger boiling up inside me.’
Like thousands of Army personnel, Andrew was given the drug to prevent malaria in the West African country.
‘We were told we could expect a range of symptoms — from very vivid dreams to confusion — but that these would be transient,’ he says.
‘Yet the effects were instant. I knew I was having psychotropic dreams — but, when you’re in a hostile military environment and a hot climate, you don’t know how much you can attribute to the drugs or the situation you’re in.
‘However, the dreams have endured and I’ve since been diagnosed formally with ‘nightmare disorder’ following my use of Lariam.’ Andrew now acts as an advocate for other service personnel affected by Lariam.
‘The reaction can be so varied and unpredictable,’ he adds. ‘When I heard the dreadful story about Alana Cutland in Madagascar, my very first thought was: ‘I wonder what anti-malarial drug she was taking?’
‘What makes me angry is that when I was given the drug — along with tens of thousands of military personnel — we were told there was no alternative. But that’s nonsense: there are alternatives.’
So why is a drug that has been linked with severe psychiatric reactions still being issued to British travellers heading for malaria hotspots?
The answer is because, in some areas, it’s one of the few drugs that works, and malaria is a very real threat to health.
Other drugs such as doxycycline and Malarone are used, too, but are not effective everywhere.
Lariam is normally taken weekly, from one week before departure, through until four weeks after returning home.
The tablets are available only from GPs as a private prescription, which costs around £20, plus £2 to £3 for each tablet. There are no statistics for how many private prescriptions a year are issued for Lariam.
Roche, the Swiss firm that makes the drug, insists its benefits outweigh the risks.
In a statement, it said: ‘Roche recommends any prescription medicine be prescribed carefully in line with the information available, knowledge of the individual patient’s health and the situation. Patients, healthcare professionals and prescribers should follow the advice provided in patient leaflets and prescribing information.’