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Toxic Cocktail: Army Struggles With Mental-Health Care

BOSTON ( TheStreet) -- On April 6, 2009, 21-year-old Army Specialist Adam Kuligowski took his rifle into a bathroom stall at Bagram Air Base in Afghanistan and shot himself. His last words were found in a suicide note to his father, Michael Kuligowski: "Sorry to be a disappointment."

Just weeks earlier, Adam had visited his dad in Thailand. Michael Kuligowski works as an information officer at the U.S. Embassy in Bangkok. During his 18-day visit, Adam had complained of sleeplessness. He had mentioned being late for work, and the push-ups he had to do as punishment. And he had talked about some extra guard duty. Michael Kuligowski is an Army veteran and saw all of that as standard-issue Army life.

There had been problems the father didn't hear about. In the fall of 2008, Adam had been ordered to kitchen duty on his days off, after he threw his gun on the ground and told his commander to send him to jail. Michael Kuligowski later learned that his son had been suffering from depression. Sleeplessness at night had left Adam exhausted during the day, when he needed to be sharp. Adam was attached to the 101st Airborne's Special Troops Battalion, tracking enemy communications as a signals-intelligence analyst.

In a report about Adam's last disciplinary meeting, a commanding officer noted that the young soldier was falling asleep in front of him. The same report showed a photo of an overturned footlocker in Adam's quarters. It noted that Adam was awake at all hours, playing online video games.

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A toxicology report on Adam's death mentioned the presence of an anti-malaria medication known as mefloquine hydrochloride. The report attached no special significance to this result, though in February 2009, just a few months earlier, Army Surgeon General Eric Schoomaker had issued a directive removing mefloquine as the Army's malaria drug of choice. Schoomaker's directive had said the drug could induce "anxiety, paranoia, depression, hallucination, psychotic behavior" and restlessness in "one per 2,000 to 13,000 persons."

Five months after Adam Kuligowski died, the military went a step further. Ellen P. Embrey, deputy assistant secretary of defense, ordered all branches of the armed forces to replace mefloquine as their top malaria drug. The national Centers for Disease Control had already established that policy with regard to the civilian population, relegating mefloquine to last among all treatment options.

Roche (RHHBY) stopped distributing mefloquine in 2008 -- its version had been marketed as Lariam -- but the drug remains available today, in generic versions produced by Novartis (NVS - Get Report) subsidiary Sandoz, Barr Pharmaceuticals (BRL) and Boehringer Ingelheim's Roxane Laboratories. Michael Kuligowski says Adam's comrades at Fort Campbell in Kentucky told him of mass distribution of the drug. The soldiers were given mefloquine in bags containing a six-month supply. They were given no information about proper use of the drug, or its well-known side effects, or potential interactions with other drugs.

"My whole issue with mefloquine is that my son's death was entirely preventable," Kuligowski says. "Everything was entirely preventable, had military medical command done its job and briefed everyone they were giving mefloquine to before they gave them mefloquine."

Kuligowski and others are concerned about the military's management of psychoactive drugs in an era of extreme stress on troops and mounting soldier suicide rates. While medical advances have provided new treatment options, they have also introduced new levels of complexity regarding treatments for malaria, depression, insomnia and post-traumatic stress disorder. The Army's critics claim it is behind the curve, and that its medical lapses continue to cost troops their lives.
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