Could Britney Spears have Neuropsychiatric Quinism? (early 2000s)
Britney Spears is in the news again for all the wrong reasons. Her fans think she has bipolar disorder. Britney believes it is Postpartum depression. Has anyone considered Neuropsychiatric Quinism?
Who is Britney Spears?
Probably one of the most famous women in music in the 2000s.
Image: Britney Spears performing during her Dream Within a Dream Tour, 2002 (source: Wikipedia)
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1. Does the situation meet the FDA Blackbox warning rule: ‘BEHAVIOUR THAT IS UNUSUAL?’
What caught my attention: It was an article via The Guardian. I’m not a big fan of Britney and didn’t know much about her but I started to read about her conservatorship in the article and some things fell into place straight away. The article: #FreeBritney movement resurges after star’s hotel fight sparks conservatorship fears. Excerpt:
Britney Spears has known the highs and lows of how the US treats its celebrities, traveling from Mickey Mouse club child actor to teen pop icon, to global superstar – and then more than a decade under legal conservatorship after a mental health crisis before winning freedom, for the first time perhaps, to be herself.
But now there are fears of a new chapter in Spears’s saga, or the return to an old unhappy one, after she reportedly had a late-night fight with her boyfriend at the Chateau Marmont in Los Angeles resulting in paramedics being called and pictures of a barefoot pop princess, mostly naked save for a pillow and a blanket, appeared in the tabloids.
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2. Was the person(s) exposed to antimalarials. If YES…
a. Which one(s)?
b. For how long?
c. Were there multiple exposures?
Not confirmed but POSSIBLE
I thought I would be looking for the period around 2008 when the Conservatorship was enacted but Britney’s mental health issues seem to commence around 2002. After reading her book in a day (it was quite good actually) I found two possible vectors around that time period.
Rock in Rio 3: Rio de Janeiro, Brazil. January 2001
From her book The Woman in Me. Excerpt:
When I think back on that time, I was truly living the dream, living my dream. My tours took me all over the world. One of my happiest moments on tour was playing the music festival Rock in Rio 3, in January 2001.
In Brazil, I felt liberated, like a child in some ways – a woman and a child all in one. I was fearless at that point, filled with a rush and a drive.
At night my dancers – there were eight of them, two girls, the rest guys – and I went skinny dipping in the ocean, singing and dancing and laughing with each other. We talked for hours under the moon. It was so beautiful. Exhausted, we headed into the steam rooms, where we talked some more.
I was able to be a little bit sinful then – skinny dipping, staying up talking all night – nothing over the top. It was a taste of rebellion, and freedom, but I was just having fun and being a nineteen-year-old.
Current CDC guidelines for Brazil in 2024 state:
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In 2001 there were four imported cases of malaria from Brazil, so it was on the radar. Until recently if you travelled overseas and it was a malarial country, they would prescribe antimalarials. Everyone was worried about malaria (quite rightly). If she was travelling to Brazil and was given an antimalarial it would have most likely been mefloquine. Taken once a week and only over a short period how would you notice. Standard advice in the 1990s and early 2000s was this:
Malaria Chemoprophylaxis for the Traveler. Circa 1993. This advice didn’t change much until the introduction of other drugs including the quinoline, Tafenoquine in 2018.
The CDC's 2000 Yellow Book, a biennial compilation of information on diseases and treatments that is used by doctors, travellers and the media, describes mefloquine as the "drug of choice" and says it is "very rarely" associated with neuropsychiatric reactions.
Dream in a Dream Tour: Mexico City, Mexico. July 2002
Britney seems to never cancel concerts unless she has literally broken something but there was a lot of chatter about the last concert in the Dream in a Dream Tour. It was in Mexico City. I wouldn’t have considered including it but this fascinating detail from her book. Excerpt:
In late July 2002, at the very end of the tour, we headed south to do a show in Mexico City. But getting there was almost a disaster.
We were travelling in vans, and once we’d crossed the border, we came to a sudden halt. We’d been stopped by a bunch of guys holding the biggest guns I’d ever seen. I was terrified; it felt like we were being ambushed. It just didn’t make sense to me, but all I knew was we were surround by these angry-looking men.
I did a double take. They drove from the US to the outskirts of Mexico City in 2002! Weird detail but important. All across the country. Mexico City isn’t considered a malarial zone, but many other states are. The current CDC advice states:
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So, she might have received antimalarials from any of her travels, but it is highly likely she took something for Brazil in 2001 and the advice states you should take it for Mexico in 2002. It would have been a prudent move to protect your million-dollar profit making machine from the known dangers of malaria.
Mefloquine has its own dangers.
Especially if you or your family has a history of mental health issues.
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3. How was the person(s) mental health?
IN A NUTSHELL, NOT GOOD
Britney Spears has a long and well documented history of mental health issues. I’m not a medical professional and she didn’t actually state what she had been diagnosed with outside of postpartum depression in her book. I’ll make the following observations though.
Mefloquine and Depression
Drugs.com states that: You should not take mefloquine to prevent malaria if you have a recent history of depression, an anxiety disorder, seizures, mental illness (such as schizophrenia), or psychosis.
In her book she finishes a chapter of her book detailing how well Oops went in 2000 with this sentence.
I also started taking Prozac.
Mefloquine and a family history of Mental Health issues
A family history of mental health issues should also rule you out for quinolines (mental health was not discussed in the 1990s, nor into the 2000s really). Britney’s grandfather, whom she seemed to adore had two of his wives committed to asylums. This excerpt from her book is worth noting:
Her husband – my grandfather June Spears Sr. – was abusive. Jean suffered the loss of a baby when he was only three days old. June sent Jean to Southeast Louisiana Hospital, a by-all-accounts horrible asylum in Manderville, where she was put on lithium. In 1996, when she was thirty-one, my grandmother Jean shot herself with a shotgun on her infant son’s grave, just over eight years after his death. I can’t imagine the grief that she must have felt
As part of her Conservatorship in late 2017 or early 2018, Britney was taken off Prozac and put on Lithium. Her description of that awful experience felt like my own.
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4. Were there any confounding variables?
YES. Too many. Here are a couple
Tough Childhood: The family went bankrupt pursuing Britney’s career. It was a tough grind for a lot of years.
The Abortion: Tough day. Not for me to comment.
The 13-year Conservatorship: My co-parent described it as being held hostage by your family.
Vicodin: Commenced taking the opioid medication in 2004 after an injury.
Postpartum depression: Or perinatal depression. She talks about it quite openly in her book.
Adderall: Britney states she wasn’t a big drinker. Her thing was Adderall, effectively a prescribed amphetamine.
Paranoia: It is mentioned a lot in the book and another side effect of Neuropsychiatric Quinism.
Partying again… People who have bipolar disorder or Neuropsychiatric Quinism should drink moderately or not at all. Everything in moderation.
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5. Was there a specific trigger?
YES. One crisis compounds into the next crisis
Her Mum states it was when she cut her hair. Britney had been in crisis for years.
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6. Other considerations?
YES. Two observations from the book
St. John’s wort
Almost immediately after the cancelled Mexico City concert, Britney’s PR team organised an interview with People magazine. This detail emerged. Excerpt:
The photographer shot me outside, and then inside with the dogs and my mom on the couch. They had me empty out my purse to reveal that I wasn’t carrying drugs or cigarettes: all they found was Juicy Fruit gam, vanilla perfume, mints, and a little bottle of St. John’s wort. “My daughter is doing beautifully,” my mom told the reporter confidently. “She’s never, ever been close to a breakdown.”
Approximately two weeks after taking St. John’s wort for a bad bout of insomnia I was experiencing in 2018, I was admitted to a mental health facility for the first time. It was sold over the counter, so I considered it safe. Stupid of me. I found out later it shouldn’t be taken if you have bipolar disorder and Neurocognitive Quinism (or both). The most recent Drugs.com health warning appended:
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Headaches
I have another observation that I might call a real concern. Almost as an afterthought at the end of her book she wrote the following:
My anger has been manifesting itself physically, especially with migraine headaches.
When I get them, I don’t want to go to the doctor because being sent to one doctor after another all those years gave me a phobia about them. And so I take care of things myself. When it comes to the migraine, I don’t like to talk about them because I’m superstitious that if I do, they’ll bother me more.
When I have one, I can’t go into the light and I can’t move. I stay very still in the dark. Any light makes my head throb and makes me feel like I’m going to pass out – it’s that painful. I have to sleep for a day and a half. Until recently, I’d never had a headache in my whole life…
Only last week was I asked this question. Did I suffer from headaches as part of my Neuropsychiatric Quinism, to which I replied that I didn’t. I get the dreams. One of the complicating factors of mefloquine toxicity diagnosis is disease is like a box of chocolates. You never know which conditions you are going to get.
So, unrelated to this I did a little reading on the weekend. And came up with a disturbing finding.
Not only are migraines a Neuropsychiatric Quinism ‘thing’, but they have also often been attributed to suicide ideation and even suicide. Including Charles Perry (1999) and John O’Callaghan (2000). I scraped the details on the weekend but didn’t use it (so I lost the source).
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ASSESSMENT
First off. Credit where credit is due. I smashed Britney’s book The Woman in Me. I really did enjoy it. Recommend.
On Neuropsychiatric Quinism. Where there is smoke, there is often fire.
Britney Spears should get a second medical opinion as it is POSSIBLE that she may have Neuropsychiatric Quinism.
In my humble opinion.
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UPDATES
31.05.2024: Britney Spears image updated
26.05.2024: Reviewed/Updated. Protocol 2 & 4 updated. References updated
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REFERENCES
Britney Spears: Unbreakable (2009) Entertain Me Publishing LTD. London, UK.
Centers for Disease Control and Prevention (2001) Malaria Surveillance --- United States, 2001 [https://www.cdc.gov/mmwr/preview/mmwrhtml/ss5205a1.htm#tab3] Paged accessed 14.05.2024
Centers for Disease Control and Prevention (2024) Yellow Fever Vaccine & Malaria Prevention Information, by Country. CDC Yellow Book 2024 [https://wwwnc.cdc.gov/travel/yellowbook/2024/preparing/yellow-fever-vaccine-malaria-prevention-by-country/] Page accessed 14.05.2024
Drugs.com (23.08.2023) Adderall [https://www.drugs.com/adderall.html] Page accessed 14.05.2024
Drugs.com (4.08.2023) Mefloquine [https://www.drugs.com/mtm/mefloquine.html] Page accessed 14.05.2024
Drugs.com (7.08.2023) Vicodin [https://www.drugs.com/vicodin.html] Page accessed 14.05.2024
Epstein, K (10.10.2000) The Lariam Files [https://www.washingtonpost.com/archive/lifestyle/wellness/2000/10/10/the-lariam-files/632d355e-33a2-41d0-b76a-c876938fa813/] Page accessed 14.05.2024
Helmore, E (12.05.2024) #FreeBritney movement resurges after star’s hotel fight sparks conservatorship fears [https://www.theguardian.com/music/article/2024/may/12/free-britney-spears-conservatorship] Page accessed 14.05.2024
New England Journal of Medicine (1.07.1993) Malaria Chemoprophylaxis for the Traveler [https://www.nejm.org/doi/full/10.1056/NEJM199307013290107] Page accessed 14.05.2024
Spears, B (2023) The Woman in Me. Simon and Shuster. New York City, New York, USA.
The Quinism Foundation (2024) The Quinism Foundation [https://quinism.org/] Page accessed 14.05.2024
Tickell-Painter M, Saunders R, Maayan N, Lutje V, Mateo-Urdiales A, Garner P (2017) Deaths and parasuicides associated with mefloquine chemoprophylaxis: A systemic review. Travel Medicine and Infectious Diseases. DOI: 10.1016/j.tmaid.2017.10.011. Included 26.05.2024
Wikipedia (2024) Britney Spears [https://en.wikipedia.org/wiki/Britney_Spears] Page accessed 13.05.2024
Wikipedia (2024) Tafenoquine [https://en.wikipedia.org/wiki/Tafenoquine] Page accessed 14.05.2024