WASHINGTON, Sept. 29 (UPI) -- A Marine from Long Island, N.Y., who served in Somalia in 1993 committed suicide seven years later, and his family now believes the anti-malarial drug he was prescribed by the military contributed to his death.
His parents say James Patrick Farrell had no symptoms of mental or emotional problems during high school or in the years before his service in Somalia. He appears to have been a model Marine.
"Patrick was a very likable guy," his mother, Bette, said recently. She and her husband, James, described their son as a handsome, popular student at Manhasset High School, where he graduated in 1984. A captain of the football team, Farrell once played against Vinny Testaverde's Sewanhaka High School team.
But after Farrell returned from Somalia in October 1993, his behavior was marked by delusions, depression, anxiety and confusion, his family said. They said he did not see combat in Somalia, so they could not establish a connection between his behavior and battlefield trauma.
They now suspect the drug Lariam triggered his instability and self-inflicted death on Jan. 31, 2000. He was 33 years old.
The Farrells said they first suspected a Lariam connection when they read about suicides and domestic killings near Fort Bragg, N.C., this summer. "When I saw it, I knew it," Patrick Farrell's brother, Kevin, said of the United Press International report that appeared in the newspaper Newsday. "I didn't have to read it twice."
Three of the soldiers suspected in the Fort Bragg incidents had taken Lariam while deployed in Afghanistan, UPI reported. Two killed themselves.
There is no way to prove whether Lariam caused Farrell's suicide. Drugmakers and government regulators point out that the actions that occur after a person takes a drug are not necessarily caused by the drug.
But by the time Farrell was given Lariam in 1993, the military and the manufacturer, Swiss drug giant Hoffmann-La Roche, were already reporting severe -- and long-lasting -- psychiatric side effects and suicidal thinking among users.
In July, Roche changed Lariam's official product label to include a warning of rare reports of suicide, but said they could not confirm any connection between the deaths and taking the drug. Roche also said for the first time that mental problems could last "long after" taking Lariam.
Soldiers, government workers and travelers have used Lariam since 1989. Around 5 million Americans have taken it, according to Roche, which is licensed by the Army to manufacture it. From 1990 to 2000, Lariam was the government's drug of choice to prevent malaria. In 2000, the Centers for Disease Control and Prevention added doxycycline and Malarone as recommended drugs.
The military continues to hand out weekly Lariam pills to troops in malaria-plagued regions, often over the alternatives, which must be taken daily.
The Farrells said no doctor ever suggested that Lariam could have caused Patrick's problems. The doctor treating him declined to comment.
A Food and Drug Administration official said in an interview last summer that the risk of side effects must always be weighed against the benefits of preventing malaria.
"Suicide in one in perhaps -- I don't know -- 1 million or however many cases you can actually calculate for Lariam may have to be acceptable on the basis for the risk for malaria," said Dr. Leonard Sacks, a medical officer with the FDA.
The Army declined to comment on the Farrell case. The Marine Corps did not return calls seeking comment.
"There are hundreds of thousands of soldiers who have taken mefloquine [Lariam's generic name]," Army spokesman Lt. Col. Ryan Yantis said in August. "We have no indication at this time that this drug is anything other than safe and effective in its proper use."
Farrell's father had served in the Marines and Patrick Farrell enlisted in 1989 after a couple of tries at college. He appears to have flourished, receiving his associate's degree and becoming a certified diver.
In a recommendation for a "meritorious corporal" award, Farrell's commander described him as "a highly motivated, industrious Marine" and "recruit poster-quality." He commended Farrell's "superior intellect and positive personal traits [that] ensure his success as a leader."
Farrell, an electrical equipment repairman, volunteered to serve in Somalia. The Marines prescribed Lariam during his four-month duty there, according to his medical records.
He returned in October 1993 and received an honorable discharge in November.
Family members said his problems were apparent immediately.
"He was different. He had a look. He was not the same guy," his father said. Kevin Farrell said his brother "just had a dead look in his eye."
He was described as unable to socialize or hold down work, failing even to show up for an interview his father had arranged for him at a construction company.
He would disappear for months at a time and once wound up broke in a men's shelter in Albany.
Once home, Farrell drank heavily and was incoherent.
"He would drive around the same roads he had known all his life and he would get lost," his sister Jennifer said.
Farrell received counseling at the Long Island Jewish Medical Center, where his medical records indicate doctors documented severe depression and psychosis during 1998 and 1999.
A therapy record from March 1, 1999, says he told doctors about a "long, convoluted paranoid delusion" and suffering from depression, psychosis, unstable moods and delusional thinking.
The Farrells described two such delusions: Patrick believed that his mother had been gang-raped and his brother had been castrated. "He was always talking about stuff that never happened," Jennifer said.
"There was no sense to it at all," James said about his son's talk.
For the last three years of his life, Patrick Farrell rarely left the house.
On Jan. 31, 2000, he went into his upstairs bedroom with his father's 30-year-old lever-action Winchester rifle. He had been complaining about pain in his head.
A neighbor heard the shot and, through a window, saw Farrell's body briefly propelled by the force of the bullet, his family said.
Bette found his body.
In May, UPI reported that evidence suggests Lariam has caused such severe mental problems that in a small percentage of cases it has led to suicide. FDA databases contain reports of a dozen suicides associated with Lariam between October 1997 and March 2002. Other suicides suspected of being associated with Lariam have occurred as long as two years after the drug was taken.
No suicides had been reported with doxycycline, a common antibiotic prescribed 25 times more often, at 9 million times each year, according to data from IMS Health, a healthcare information company.
Hoffman-La Roche and the military had considered such issues a decade ago. A study published in the Journal of Tropical Medicine and Parasitology in 1993 said that two of 359 Marines given Lariam became so depressed and suicidal they had to be hospitalized. But the study said that U.S. military doctors concluded their symptoms were not due to the drug and the soldiers "were withdrawn from the study."
The study then concluded that Lariam was "well-tolerated" by the Marines.
A year earlier, a report by three scientists employed by Roche found that "serious and occasionally prolonged psychiatric and neurological effects occur in patients" taking Lariam, but that "such events are rare."
Researcher Stefany Moore in Washington contributed to this story.
