“HYDROXYCHLOROQUINE & AZITHROMYCIN, taken together, have a real chance to be one of the biggest game changers in the history of medicine.” President Trump tweeted this in response to a poorly conducted clinical trial.
Despite warnings from his scientific advisers, he told the world that anti-malarial medications like hydroxychloroquine and chloroquine could revolutionize the treatment of Covid-19. But whether the president knows it or not, these medications can have very serious psychiatric side effects. Furthermore, the public may not know this. And there has now been an alarming surge in people looking for these medications. Pharmacists have told us they are out of stock, in part because some doctors — including dentists — are reportedly stockpiling the medications for themselves and friends and families. Non-physicians are calling in fraudulent prescriptions for themselves.
As psychiatrists, we are worried about the shocking increase in people self-medicating with these drugs. To emphasize this point: These are not harmless medications. They could have serious consequences — like death.
That’s not theoretical. An Arizona man died (and his wife is in critical condition) after ingesting chloroquine phosphate, which in one formulation is sold to clean fish tanks. Similar overdoses have been reported internationally.
Furthermore, patients who truly need these medications for serious conditions like lupus are going without treatment. Some states have been forced to limit dispensing them.
Doctors have known for decades that chloroquine and related medications like hydroxychloroquine and mefloquine can cause psychiatric side effects even after just one dose. While some patients experience mild anxiety, insomnia and nightmares, others have severe symptoms like personality changes, paranoia, hallucinations and even suicidal thoughts.
Here’s one example of the impact these drugs can have: A 74-year-old woman, with no mental health history and otherwise doing well, was admitted to a psychiatric facility because she insisted her neighbors were shooting electromagnetic waves into her apartment. She said they were using these waves to spy on her and to destroy her brain. Her doctors were puzzled — until they discovered that she had recently started on chloroquine to treat her arthritis. Once the medication was stopped, she fully recovered.
Mental health changes are not the only risks we see. Chloroquine and azithromycin can also affect the heart’s normal rhythm by prolonging the “QT interval,” the time it takes for the large chambers in the heart to relax after pumping out blood. If the QT interval becomes too long, it can lead to abnormal rhythms, or arrhythmias, where the heart starts beating out of control. This change can cause death. The patients at risk of this are the same ones who are most vulnerable to Covid-19: the elderly and those with chronic illnesses. So while the president may claim these medications are “not killing people,” we know and have seen that in some cases they do.
All medications have side effects, and nothing is without risk. This is why our F.D.A. approval process, though long, exists to ensure the safety and efficacy of the medications we prescribe. We rely on the F.D.A.’s information, and as physicians, we carefully weigh the pros and cons of each medication for each patient before prescribing.
But in the case of chloroquine and similar medications for Covid-19, we’re still working out whether there are any benefits. So we can’t have discussions that weigh the risks versus benefits. Knowing that chloroquine has notable psychiatric side effects and cardiac effects, we can’t recommend people just take it without fear of consequence. As we get more data, things may change. Given this uncertainty, the medications should be used only in carefully considered serious situations, not by dentists and non-physicians.
This is especially true given the risk of psychiatric symptoms during quarantine and self-isolation. We have already seen an increased use of suicide hotlines and the veterans crisis line. Discussions of anxiety and insomnia are all over social media. During previous pandemics, like the Spanish flu of 1918-19, cases of psychosis and hallucinations increased significantly.
We would love to be able to say we have a treatment for Covid-19. It is nice to think about a cure, especially when things seem to get worse every day. But we implore you to follow medical professionals’ advice and not get or take an experimental medication recommended without evidence of its success. If you have no psychiatric history, we’d rather you stay that way.
Dr. Jessica Gold (@drjessigold) is an assistant professor of psychiatry at Washington University in St. Louis. Dr. Chandan Khandai (@chandan_khandai) is an assistant professor of psychiatry at the University of Illinois at Chicago. Dr. Pooja Lakshmin (@poojalakshmin) is a clinical assistant professor of psychiatry at the George Washington University School of Medicine. Dr. Jack Turban (@jack_turban) is a resident physician in psychiatry at the Massachusetts General Hospital.
The Times is committed to publishing a diversity of letters to the editor. We’d like to hear what you think about this or any of our articles. Here are some tips. And here’s our email: email@example.com.