Mefloquine Dreams

Mefloquine is the first choice of antimalarial medications given to Peace Corps volunteers.  The literature given to me along with my first dose includes the following statement:

This medication may cause stomach upset, stomach pain, nausea, vomiting, diarrhea, headache, insomnia, vivid dreams, or lightheadedness. Contact your Peace Corps health provider immediately if any of the following side effects occur: unexplained anxiety, mood changes, depression, hallucinations, restlessness, or confusion. (Italics my own)

 With many of these side effects, it can be hard to blame Mefloquine alone.  For example, diarrhea  can come from pretty much anything African.   However, the vivid dreams and hallucinations…that’s gotta be Mefloquine. 

After taking his first dose, my friend Tommy had a very real-seeming dream that Lady Gaga came to his house to tell him how proud of him she was for doing Peace Corps.  After hearing about this dream, I dreamt that I ran into Lady Gaga in Paris and told her all about Tommy’s dream.

If you ask a group of volunteers about their craziest Mefloquine dreams, you’ll get a flurry of shouting and laughing as they recount these ridiculous dreams that are at times so vivid you can’t quite wake up from them.  When I asked a group at the Kedougou regional house this question, the best responses I got were:

“I dreamed that I was a serial killer out to get all of the heroines from 90s movies, like the girl from Dumb and Dumber.  There were a lot of shoulder pads.”

“I had a dream that was like an old school video game.  I was flying on the back of a dragon, and we were flying through 3-D purple mountains.” 

Maybe reptilian dreams are common because of the abundance of lizards in Senegal.  I had a dream that two giant lizards that looked like rainbow stegosauri had gotten into the Thies training center and that I had caught them by their spikes and was trying to get Pat to take a picture but he wouldn’t.  My alarm went off and I grumbled at Pat, “Why couldn’t you get a picture of the dinosaurs?”

There is a very popular tv show imported from India called Swargo that is the most ridiculous thing I have ever seen.  The excessively long shots of overly dramatic facial expressions are just too much.  We were watching it with our family at training one night, and Pat says, "So that guy is an alien, right?"  This show is a soap opera about arranged marriages and such...no sci-fi involved, but his dream in which this character turned out to be an alien had been so vivid, he didn't really even question it.

But people have crazy dreams all the time, you might say.  How about hallucinations though?  During community-based training, I would wake up on almost a nightly basis and be convinced that Pat was a member of my host family.  He really looked black to me.  Most of the time I would realize it was him within a few seconds, but on one particular night, I was absolutely convinced that he was Kamkou, our 19 year old host sister.  I was really freaked out, and kept trying to ask her (in my novice levels of Jaxanke) where Pat was and what she was doing in bed with me.  This went on for long enough that I think it falls in the hallucination category.

Despite the lack of sleep all of this sometimes caused, it was mostly funny and I wasn’t worried about the other listed side-effects of Mefloquine, like unexplained anxiety or depression.  Then, about the time we got to site, Pat started feeling crippled with anxiety.  He was driven crazy by the thought that people in our site might be burning mercury (a common practice in the gold mining villages in the area) and couldn’t think about anything else.  When he broke down crying on the phone with his mom about mercury, she started to look into Mefloquine.  She found that it has been banned from use by the US Army because of negative psychological effects and found a compelling number of both testimonials and medical providers suggesting to avoid the drug.  He called the Peace Corps Medical Office and told them about what he was experiencing, and they put him on a different drug, Doxycycline, right away.

Pat noticed a change within a week.  He would take the Mefloquine on Thursdays, and then feel the most anxious on Saturdays.  Since Doxycycline is also an antibiotic, it conveniently helped clear up a persistent case of diarrhea.   He was feeling so significantly better about things that he started trying to get me to consider changing my malaria prophylaxis.  I was very resistant.  Apart from the dreams and occasional hallucination, I felt fine and attributed any extra anxiety to the fact that we were trying to make our way in a new and very different place in extremely hot temperatures.  Plus, Doxycycline makes you extra sensitive to the son and can interfere with the effectiveness of birth control pills.

The unexplained, and desperate, anxiety hit me a few weeks later.  It was a Saturday, the one time a week when electricity is on in the afternoon, and I didn’t have anything I needed to do.  It occurred to me that I could take my first nap of my Peace Corps service.  (It should be noted that many Senegalese and volunteers take daily after-lunch naps, so there’s nothing to feel logically guilty or anxious about regarding this activity.)  I lay down and after five minutes my head felt like it was going to explode with spinning thoughts about how I should be out greeting and drinking tea.  I knew I should not be feeling this way, but I could not let myself relax and take a minute to myself to rest.  I was anxious to the point where my thoughts were scaring me. I started crying really hard and exclaiming how this was my worst day of Peace Corps.   At that point, Pat said he was going to throw my Mefloquine down the toilet (and my toilet I mean the hole in the concrete slab in our back yard).  He pointed out other crazy anxieties I had been exhibiting and made me promise not to take it again, since I had refused to waste medicine. 

Later that week, a Peace Corps doctor came to Kedougou to discuss our potential for mercury poisoning (sidenote: our risk was listed as limited but we still have to get tested at some point).  I took the occasion to make a request to get put on Malarone, a third prophylaxis option that is so expensive that they have to get permission from Peace Corps Headquarters in Washington in order to prescribe it.  I told the doctor about my increasingly overwhelming anxiety issues, and said that it made me even more anxious to think about a decreased efficacy of my birth control pills.  Being a married volunteer has its perks, and Washington must have figured that the $7/day prescription for two years was still less expensive than paying for a baby (prenatal care and delivery are covered by our insurance, but we would get sent home).

Sure, I still have anxiety and hard days.  Constantly navigating a new culture and being under the spotlight 24/7 is an anxiety producing way of life.  But I haven’t had any (entirely) unexplained meltdowns lately and I really do think the difference came gradually as the Mefloquine left my system.  There are some volunteers that go the whole two years with Mefloquine, but almost all Kedougou volunteers who I trained with have had to change for one reason or another.

I actually started thinking about writing a post on the theme of Mefloquine back in the days of just vivid dreams at training, having no idea that things would go the way they did for us.  But the Mefloquine dreams turned into Mefloquine woes, and Peace Corps is hard enough as it is.