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.
A trail of human wreckage The record of problems relating to mefloquine is a long one. In December 2002, Naval Lt. Cmdr. Bill Manofsky was given Lariam, the Roche version, during his deployment to Kuwait. There was no prescription and no warning about side effects, as far as Manofsky can recall. Three days before the Iraq War began, in March 2003, Manofsky experienced uncontrolled vomiting and vertigo while operating in the Kuwaiti desert. Two months later, back home in China Lake, Calif., he had a panic attack on the way to a local restaurant. He tried to jump out of the truck his wife was driving and, when they arrived at the restaurant, threatened to kill himself, ending the evening at an emergency clinic. Today, Manofsky is a veterans' advocate who questions the quality of medical care given to active-duty soldiers and veterans. "There is a tremendous amount of dysfunctionality in Army medical, to the point that the Army surgeon general can put a directive out and it can be ignored," Manofsky says, referring to the Schoomaker advisory. "I would never go into the Army the way it is now. I am telling them, 'People, don't send your kids to the Army until the medical stuff gets fixed.' " About the same time Manofsky first experienced problems, four soldiers at Fort Bragg, N.C., killed their wives before three of them took their own lives. Three of the four had been taking Lariam before the shootings. As evidence of problems associated with mefloquine mounted, the Army seemed slow to recognize the pattern. In February 2004, the Army surgeon general at the time, James Peake, testified before a House Armed Services subcommittee that an Army investigation had found no link between Lariam and soldier suicides. A month later, U.S. Chief Warrant Officer Bill Howell, who had taken Lariam while deployed with Special Forces in Iraq, shot and killed himself in the front yard of his Colorado home. His wife suspected Lariam had a role in his death. A study released that same month by doctors at the Walter Reed Army Institute of Research bolstered her claim, finding that a quarter of the individuals taking Lariam to prevent disease and nearly three-quarters of those taking it as a treatment experienced damage to their central nervous systems. That report cited psychological disorders such as hallucination and insomnia, and neurological disorders like seizures and dizziness. On July, 11, 2004, 25-year-old Army reservist John Torres killed himself with an M-16 while stationed at Bagram, where Adam Kuligowski would later die. A report that mentioned the presence of Lariam in Torres' system, together with a bit of strange phrasing in Roche's medication guide on the drug, were among Michael Kuligowski's first clues that mefloquine may have played a role in his son's death. Roche's guide said: "Some people who take Lariam think about suicide. Some people who were taking Lariam committed suicide. It is not known whether Lariam was responsible for those suicides."
The drug fair Manofsky argues that a modern battlefield is no place for a drug that can damage the nervous system. He questions the Army's sensitivity to the issue. One of his first cases as a veterans' advocate was that of Army Special Forces Staff Sergeant Georg-Andreas Pogany. In September 2003, while stationed in Iraq, Pogany experienced panic attacks and hallucinations and told Army doctors he was on his way to a nervous breakdown. He was given Sanofi-Aventis' ( SNY) Ambien to help him relax. An Army psychologist told him to rest. Then the Army sent Pogany back to his base at Fort Carson, Colo., and charged him with cowardice, a rare charge that is punishable by death under the Uniform Code of Military Justice. Pogany and his attorneys established that his mental condition was likely attributable to Lariam and to that drug's known interaction with Ambien's core drug, zolpidem. Consequently, the Army finally dropped the charges. He went on to serve as an attorney for veterans with mental-health issues and today works with the nonprofit military mental health service provider Give an Hour. In Pogany's eyes, military policy on psychotropic and antipsychotic drugs is a disaster, and U.S. soldiers are the victims. Not only has the Army lost track of the psychological side effects of drugs like mefloquine, Pogany says, it is also over-using other psychoactive drugs, particularly sedatives and anti-depressants. "They medicate people for two reasons: One is to calm down and the other is to sleep, so they put you on anti-anxiety meds and sleep meds so you can perform your mission," Pogany says. "The way one soldier described it to me is that they are constantly on uppers and downers." A March hearing conducted by the Military Personnel Subcommittee of the Senate Armed Services Committee supported Pogany's view. At the hearing, Sen. Jim Webb (D-Va.) estimated that one in six service members is now taking some form of psychiatric drug. Army Surgeon General Schoomaker says between 3% and 6% of the 550,000 troops currently deployed are taking drugs for mental health or stress, that 8.6% have been given antidepressants, anxiety medications or sleep aids, and that 34% have two or more prescriptions.
Suicide spike Controversy over drug policies is increasing in tandem with the military suicide rate. Last year, the Army recorded 162 active-duty suicides, a number that has steadily increased every year since 2004. That number jumps to 239 when non-active duty personnel are included. And the total doesn't factor in the 1,713 known suicide attempts that took place during the same period. The suicide rate in the Army has exceeded that of the civilian population in recent years, a reversal of the historic relationship. By mid-July 2010, the total number of soldier suicides for the year had already climbed to 140. It was in July that the Army released a far-reaching report on military suicides and measures that might reverse the recent upward trend. The report noted that, of the soldiers who committed suicide in 2009, 16.7% seemed to have been motivated by a desire for "emotional relief," while 11.1% cited "hopelessness and depression" in discussing their problems. The Army report recognized the toll that stress takes on combat troops. Among the known stressors for active-duty suicides, diagnosis of a behavioral or mental-health problem was cited in 48% of cases. Those diagnoses included the vague "adjustment disorder" (26%), substance abuse (18%) and post-traumatic stress disorder (9.1%). The report said the number of soldiers prescribed antidepressants jumped from 1.1% in 2005 to 5% in 2008. The Army has acknowledged that antidepressants can increase suicidal behavior in soldiers ages 18 to 29. But the report blamed the suicide spike largely on the "high-risk behavior" of soldiers -- including heavy use of illegal drugs and "suicidal behavior" -- not on the drugs themselves or those prescribing them. Pogany, the veterans advocate, was not appeased. He is incredulous that mefloquine is still affecting families like the Kuligowskis. "This kid was killed by mefloquine, and that happened seven years after my incident happened," Pogany says. "The fact that, seven years later, this drug is still in use and Congress has never done anything or called anyone to testify, and that they tried to criminalize my reaction to the side effects of this drug by court-martialing me is absolutely ridiculous." Michael Kuligowski knows he can't sue the Army, as Supreme Court precedent effectively prevents the families of military personnel from filing wrongful-death claims against the U.S. government. Yet he feels the Army owes him something. "I really feel like it was medical malpractice on their part," Kuligowski says. "Whoever the physician was who handed him this stuff wasn't trained about mefloquine, and it opened my eyes to the fact that you can't assume everything's going to be OK. I learned not to trust the military." Critics say the Army remains partially blind. Jeanne Lese has spent 13 years hearing stories from soldiers and loved ones suffering the effects of mefloquine. She co-founded Mefloquine Action (formerly Lariam Action) as a support group in 1997. She says the military continues to ignore Schoomaker's mefloquine directive and administers the drug without regard for manufacturers' directions. She believes the military still isn't giving soldiers important information about side effects. She faults the military's screening processes, which she says routinely fail to consider contraindications and allergies. "Nobody is trained, nobody knows what to do," Lese says. "Nobody would recognize a side effect if it hit them in the face." --Written by Jason Notte in Boston.
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