Welcome to Sydney Morning Herald = Online.=20 Skip directly to: Search=20 Box, Section=20 Navigation, Content.=20

A bitter pill

June 19, = 2004

The day Merrilee Bentley tried to kill herself and her two daughters = began=20 like every other day she endured last winter. Some time around 8am, = Bentley=20 awoke in a fog of fatigue and listlessness, shuffling into the kitchen = of the=20 small bungalow she shared with her husband, Mat, in the orchard country = south of=20 Perth. Her 10-year-old daughter Ally was getting ready for school, = two-year-old=20 Lauren was awake, and Mat was preparing to leave for his job at a local = sawmill.=20 Bentley tried to help with breakfast, but felt overwhelmed by = exhaustion. She=20 thought about asking Mat to stay home from work, but money was tight, so = she let=20 the idea pass. In the kitchen, she made herself a cup of coffee and = swallowed=20 two tablets of Effexor, the antidepressant she'd been taking in = ever-increasing=20 doses for six months.

At 31, Bentley was in the grip of a fearsome depressive spiral. The = previous=20 year she had tried to kill herself four times, twice by hanging. Each = new day=20 now brought incessant thoughts of suicide, as if a malignant growth had = taken=20 root in her mind. On this particular day, her social worker was = unavailable and=20 she began to feel increasingly agitated. Almost as if she were fleeing = her own=20 thoughts, Bentley grabbed the car keys and resolved to drive 220 = kilometres=20 north-west to Perth. She put Lauren in the car, picked up Ally from = school, and=20 was heading west to Bunbury when a familiar idea began gnawing at her. =

=20 Advertisement

"I was thinking, 'No one cares. No one's there. I'd be better off = dead.'" A=20 year later, Bentley still cannot recall the events of that day without = sobbing.=20 "And because my children were with me, they kind of came into the = argument in my=20 head: should I just turn around and take them somewhere, or should they = come=20 with me? And the argument in my head was, 'No, don't let them be without = a=20 mother.' So I convinced myself to take them with me."

After driving into Bunbury, Bentley hocked her wedding ring for some = cash and=20 bought a length of rubber hose. At a Hungry Jack's restaurant, she sat = watching=20 her children in the playground while she composed a letter to them, = expressing=20 her sorrow for what she was about to do. Putting the girls back in the = car, she=20 drove north for nearly an hour and pulled over at a wayside stop off the = highway=20 near Waroona. She ran the hose from the exhaust pipe into the back = window,=20 telling the girls it would warm the car, and sat in the back with them,=20 listening to the radio. But the hose was kinked, and nothing happened, = so=20 Bentley tried to shake herself free of her death wish and drove on = towards=20 Perth.

"I stopped at a petrol station, and Ally asked for a bottle of Fanta. = And I=20 looked at the bottle and thought, 'That'll fit on the exhaust pipe.' And = all=20 these thoughts came back - just on and on and on and on. I bought some = tape and=20 I bought scissors, and I cut the bottle and put it on the pipe. I found = another=20 car park and I put the bottle on the exhaust and put the hose in the = window. I=20 could smell the fumes a lot more.

"I really thought you just fell asleep. We were sitting in the back = seat, and=20 after about 10 minutes Ally said, 'It stinks.' I said, 'Just rest,' = still=20 convincing myself I had to do this. Then my eyes started to sting a bit, = and I=20 was getting confused. And Ally was starting to hold her nose and Lauren = was=20 starting to cry and get upset. Ally said, 'It's horrible,' and I said, = 'Well,=20 get in the front.' So she got in the front seat for about 30 seconds and = I saw=20 her going towards the door and I said, 'Just get out,' as she was = opening the=20 door.

"Then I got really angry with myself, because although I knew what I = was=20 doing, I didn't actually want to cause them any pain. I didn't want to = hurt=20 them. So I opened the back door, sat Lauren on the back seat, and I went = and got=20 the hose and ripped it out and threw it in the bush."

In the weeks that followed these few hours, Bentley's life = disintegrated. Her=20 fragile marriage collapsed, her children were taken away from her, and = she found=20 herself huddling in a concrete police cell in Bunbury charged with = attempted=20 murder, before being sent to Graylands psychiatric hospital. But amid = all this=20 trauma, separated from everyone she knew, she also came to a pivotal = decision:=20 on July 5, a week after her antidepressant dosage was increased to 450mg = a day,=20 Bentley stopped taking Effexor. Within days, she began to feel better. = Her=20 energy returned, the suicidal obsession ebbed away, her mind cleared. By = September, a psychiatrist pronounced her free of depressive = symptoms.

Today, Bentley is convinced that Effexor drove her to the brink of = murder,=20 and last month the Chief Justice of Western Australia came to much the = same=20 conclusion. The implications of that carry far beyond Bentley's life, = because=20 her case is simply the latest in a succession of tragedies that have = raised=20 persistent and disturbing questions about the "miracle" of modern=20 antidepressants.

In the history of drug-induced euphoria, there has never been = anything quite=20 like the Prozac phenomenon. Launched by Eli Lilly

in 1988, this tiny pill came to embody the seductive promise that = science had=20 found the key to human happiness. Prozac regulated the brain's serotonin = levels=20 and thus, it was claimed, made people "better than well". It became a = cultural=20 touchstone - dissected on talk shows, emblazoned on countless magazine = covers,=20 name-checked in pop songs and movie titles, extolled in countless = best-selling=20 books. It spawned its own buzz-phrases - Prozac Nation, Listening to = Prozac -=20 and reaped billions of dollars for the pharmaceutical industry, which = quickly=20 launched a range of copycat drugs like Zoloft, Aropax, Paxil and Luvox. =

These drugs, the selective serotonin reuptake inhibitors (SSRIs), = were said=20 to be non-addictive, came in a one-size-fits-all dose and were virtually = impossible to overdose on. But from the very beginning, the effusive = testimonies=20 of people who had experienced the "Prozac miracle" were shadowed by = other=20 stories from people who underwent bizarre transformations, becoming = agitated,=20 aggressive, emotionally blunted and suicidal.

A series of violent murders and suicides linked to the drugs sparked = alarm in=20 the early 1990s, but the drug companies successfully fought off = lawsuits, and=20 the US Food and Drug Administration (FDA) reviewed the evidence and = pronounced=20 them safe.

By the late 1990s, however, several drug companies had been forced to = hand=20 over their internal records to personal injury lawyers, and it became = clear they=20 had suppressed damaging data. In 2001, a Wisconsin jury ruled that the = SSRI drug=20 Paxil had caused

60-year-old Donald Schell to kill his wife, daughter, granddaughter = and=20 himself in a shooting frenzy. Three weeks earlier, a NSW Supreme Court = judge=20 ruled that an overdose of Zoloft had caused 76-year-old David Hawkins to = strangle his wife. Drug companies have settled dozens of lawsuits. = Meanwhile,=20 British health officials last year banned the use of all SSRIs except = Prozac for=20 treating under-18-year-olds, revealing that clinical trial data on Paxil = - which=20 the drug company GlaxoSmithKline had suppressed - showed an increased = risk of=20 suicidal behaviour for minors.

According to the Los Angeles Times, an unreleased report last year by = the FDA=20 came to very similar conclusions, in particular about Paxil and Effexor. = US=20 health authorities are now reviewing all data on SSRIs, and many drug = experts=20 are now acknowledging there may be a dark underside to the SSRI = phenomenon.

Prominent among them is Dr David Healy, a clinical researcher from = the UK.=20 Healy has worked as a consultant to many of the major drug companies and = written=20 several books on the history of psychiatric medicine. He remains a firm = advocate=20 of drug treatment for depression and thinks SSRIs work well for many = people. But=20 he has become the drug industry's worst nightmare: an authoritative = expert who=20 believes SSRIs are also killing thousands of people every year.

In his latest book, Let Them Eat Prozac, Healy uses drug company = research=20 data and his own expertise to argue that SSRIs may induce suicidal = thoughts in=20 as many as 1 per cent of patients. (If that sounds like fairly small = odds,=20 consider that 50 million prescriptions for these drugs have been written = in=20 Australia since Prozac came on the market.) What's more, Healy says, the = pharmaceutical industry knew this from the beginning but hid the problem = by=20 sanitising the data. And, in doing so, they enlisted the help of many = scientists=20 who accepted industry money to conduct research, or attached their names = to=20 ghost-written research papers.

A case in point is Effexor, the drug Merrilee Bentley was taking when = she=20 tried to kill her children. Healy recalls that several years ago, he was = invited=20 to a luxury convention centre on the Californian coast where Wyeth=20 Pharmaceuticals, Effexor's manufacturer, was sponsoring a conference on=20 depression. As part of the deal, Wyeth had paid ghost writers to draft a = "David=20 Healy" paper which he could present on the difficulties of achieving = "full=20 remission" of depression - a phrase which happily coincided with Wyeth's = marketing campaign for Effexor. Healy declined the offer, but the = article=20 subsequently appeared in the Journal of Psychiatry and Neuroscience, = under=20 another researcher's name.

Healy's outspokenness has incurred the full wrath of mainstream = psychiatry.=20 At a recent symposium on antidepressants in Sydney, one psychiatrist, Dr = Olav=20 Nielssen, dismissed Healy's work in a few sentences and said "there's a = word in=20 Yiddish I could use to describe him". Professor Ian Hickie, director of = the=20 Brain and Mind Research Institute at the University of Sydney, says = Healy is a=20 "hired gun" who uses selective research to help people sue drug = companies.=20 Hickie points out that the suicide rate among older Australians, who are = prescribed the lion's share of antidepressants, has fallen since the = advent of=20 SSRI drugs. Furthermore, he says, doctors are extensively educated on = the side=20 effects of these drugs and appropriate warnings for patients.

That wasn't the case, however, for Merrilee Bentley. In all her years = seeking=20 treatment for depression, Bentley cannot remember a doctor ever warning = her that=20 antidepressants might worsen suicidal impulses.

She was first diagnosed with depression as a child, after her mother = left=20 home on Christmas Day 1978, leaving her father, Philip Wright, with four = daughters under the age of 13. Wright remarried and his new wife, Avril, = developed a strong bond with the girls. But Merrilee was the youngest = and most=20 emotionally vulnerable of the sisters, and fear of rejection became a = recurring=20 motif in her life.

At 16, she left home, eventually moving in with her biological mother = in=20 Bunbury, 180 kilometres south of Perth. It was a fraught relationship, = however,=20 and the events of 1978 were never really resolved. By 22, she had a son, = Carl,=20 and a daughter, Ally, with her then boyfriend, Daniel. But Daniel became = violent=20 and she moved 50 kilometres inland to Collie, struggling to cope with = life as a=20 single mother.

"I'd say that's when it started," she recalls, sitting in the lounge = room of=20 her father and stepmother's home in bushland near Collie, on a late May=20 afternoon. "Being a single mum, being lonely, meeting guys who just = wanted to=20 have sex with you." She sighs. "Just longing to be loved. In 1995, I = tried=20 Prozac, which really didn't agree with me - it made me a bit aggressive, = a bit=20 angry."

It's almost a year since Bentley tried to kill herself and her = children, and=20 for all the tears and sorrow that punctuate her conversation, it's clear = she has=20 undergone a remarkable transformation. A year ago, she weighed 76 = kilograms and=20 was "a walking vegetable". Today, she is 20 kilos lighter and has been = drug-free=20 since September. The dark circles under her eyes hint at the = difficulties she is=20 still grappling with: her children have been in the care of various = relatives=20 since June 2003 and she is not allowed to see them without supervision; = she has=20 separated from her husband and lives in a small bungalow near her = father's=20 house; she has pleaded guilty to four counts of attempted murder (two = for each=20 child) and is scheduled to be sentenced by the WA Chief Justice the day = after=20 our interview. But despite it all, she talks with resolute candour about = the=20 calamitous events of the past year.

Like so many people suffering depression and stress, Bentley turned = to her=20 local doctor for help and was handed a packet of pills. After Prozac she = tried=20 Zoloft, but it made her nauseous. In August 1996, she met her current = husband,=20 Mat Bentley, who was six years her junior, but the relationship was = stressed=20 from the beginning by the disapproval of his family. Acutely sensitive = to the=20 smallest rejection, Bentley first had suicidal thoughts after an = argument with=20 Mat in early 1998, around the time she was first prescribed Aropax. = Whether the=20 suicidal thoughts followed the Aropax, or vice versa, is unclear.

It's this very issue that sparks the fiercest arguments in the = antidepressant=20 debate. Depressed people often feel suicidal, so drug companies have = long argued=20 that the illness, not the drugs, is the problem. Critics like David = Healy, on=20 the other hand, say SSRIs can trigger the very symptoms they're supposed = to=20 treat, which makes detecting their side effects a nightmare. It's a = circular=20 argument which is almost impossible to resolve. What's indisputable = about=20 Merrilee Bentley's case is that she attempted suicide only after she was = prescribed the drugs, and her condition worsened as her dosage = increased.

In February 2000, as Bentley became stressed by the family squabbles=20 surrounding her impending marriage to her boyfriend, her GP put her back = on=20 Aropax. Five weeks later she became suicidal and was hospitalised. = Things=20 stabilised after she fell pregnant with her third child, Lauren, but in = mid-2002=20 her condition again nosedived. Her son Carl had to move to his paternal=20 grandparents' home in Bunbury for schooling reasons; money was so tight = the=20 Bentleys had been forced to rent out their house in Collie and move into = the=20 bungalow on Philip Wright's property with the two girls; and Bentley had = become=20 overweight from a thyroid problem.

In May 2002, she attempted an overdose of Aropax, a futile act which = suggests=20 how little she had been told about the drug (death by SSRI overdose is = virtually=20 impossible). In response, doctors doubled her dosage. Some months later, = she=20 tried to hang herself in her father's shed after an argument with Mat, = only to=20 be discovered by a friend.

There was a pattern to these incidents, one of extreme overreaction = to normal=20 life stresses. In the latter half of 2002, Bentley's grandmother died = and Lauren=20 was burned by a scalding cup of coffee which the toddler tipped off a = bench. In=20 November, Bentley again attempted an overdose and was rushed to Collie = Hospital=20 by her father. Absconding from the hospital, she wandered around Collie = barefoot=20 before calling the police and being taken to the psychiatric ward of = Bentley=20 Hospital in Perth. There she took the cord out of her pants and tried to = hang=20 herself in her room.

"I was in there for ... I don't know how long, perhaps a week," she = recalls.=20 "Don't remember. And during that time they changed me from Aropax to = Effexor." A=20 psychiatrist's report - remarkably, Bentley says this was the first time = she was=20 referred to a psychiatrist - noted an improvement under Effexor, so the = dosage=20 was doubled from 75mg to 150mg after she was released from hospital. By = January=20 last year she was at home and on 300mg a day.

Mat Bentley recalls watching his wife get worse with each increase in = dose.=20 "It never improved," he says. "She was more on edge, doing less around = the=20 house. Some days I would get home from work and she was still in = bed."

On Effexor, Merrilee Bentley recalls, the suicidal thoughts that had=20 previously been intermittent surged in strength and frequency. Each = increase in=20 dosage induced a zombie-like state for a week, followed by overwhelming=20 lethargy. "A lot of it's a blur, but one thing I really remember is just = sleeping. Feeling so tired, and thinking at the end of the day that I = was=20 nothing. Nothing would cheer me up.

I'd get agitated easily, fly off the handle easily, at other times be = curled=20 up in a ball crying for nothing major. My mental fixation at the time = was death,=20 and that's all I thought about." Inside her head, she says, was a battle = between=20 her rational self and an irrational other who promised that suicide = would bring=20 relief.

"I went to my GP in March and told him, 'I think about suicide all = day, every=20 day - even on a good day.' I really think he should have known something = was=20 wrong then. But he let me walk out the door." (The doctor's notes record = her=20 condition as "going okay, mildly suicidal thoughts".) It took another = three=20 months before Bentley finally succumbed, in that car park on the highway = north=20 of Bunbury on June 17, to her obsessional impulse to kill herself. In = the=20 distorted thinking of that moment, she argued that by taking her = children with=20 her, they would be spared the pain of living without a mother.

Bentley waited until the following morning to confess to her husband = what she=20 had done. She made full admissions to a social worker, was briefly = hospitalised,=20 and on June 24 her daughters were taken away by welfare officers. On a = Saturday=20 afternoon 10 days later, police met her at her mother's house in Collie = and told=20 her she was to be charged with four counts of attempted murder. After = driving=20 her north to the scene of her crime and asking her to re-enact the = events for a=20 video camera, they took her to Bunbury lock-up to be strip-searched and = put on=20 suicide watch in a cell.

"Then I crashed. I was sitting on the floor, rocking, and I called = them and=20 said if they didn't get me to a doctor I was going to kill myself." It = was only=20 then, when Bentley realised she had nothing left to lose, that she = resolved to=20 try to wrest back control of her life.

A week earlier, a psychiatrist had upped her dosage of Effexor to = 450mg -=20 twice the recommended maximum for mild depression. But only a few days = after=20 that, she'd read an article in The West Australian newspaper that = revealed=20 something no one had ever told her

- that antidepressants can sometimes trigger mood disorders. On the = day she=20 was arrested, Bentley had taken only one Effexor instead of three. By = the=20 following day, when police transferred her to the psychiatric ward of = Graylands=20 Hospital, she'd stopped taking Effexor completely. Appearing in Bunbury=20 courthouse to face her charges 24 hours later, Bentley was a shivering = mess,=20 convulsed by nausea as her body went cold turkey. To ease the symptoms, = she=20 began taking a low dose, and by Thursday she was in her room at = Graylands=20 experiencing an "almost indescribable" change.

"I have energy and can think more clearly and the suicidal thoughts = that=20 plagued me on a daily basis have now been replaced by the ability to = think more=20 objectively and positively," she wrote in a notebook. "It is truly an = amazing=20 feeling." Suddenly it seemed clear that the force which had pulled her=20 inexorably towards suicide was not her depression, but the drugs - a = realisation=20 that triggered an understandable anger. "I feel," she wrote, "that the = doctors,=20 psychiatrists and other medical and mental health 'professionals' that I = have=20 spoken to since my first suicide attempt have completely failed me."

Last year, 10.1 million antidepressant prescriptions were handed out = in=20 Australia, according to the Health Insurance Commission, nearly double = the=20 amount in 1996. To mainstream psychiatrists, this is a heartening sign = that the=20 depressed are finally getting treatment and the stigma of the illness is = lifting. But an increasing number of doctors are concerned: SSRI drugs = are now=20 routinely prescribed for conditions such as hyperactivity, anorexia and = stress.=20 A quarter of a million prescriptions last year went to children and = adolescents,=20 at a time when the safety of these drugs for minors is under a = cloud.

Dr Jon Jureidini, head of the department of psychological medicine at = the=20 Women's and Children's Hospital in Adelaide, has voiced concern about = the=20 over-prescription of these drugs and their possible links with suicidal=20 behaviour. And Dr Yolande Lucire, a Sydney forensic psychiatrist, told a = recent=20 meeting of forensic scientists that she has observed significant numbers = of=20 people entering hospital with SSRI-induced mania and psychosis.

On a chilly Wednesday morning at the Supreme Court in Perth last = month,=20 Merrilee Bentley appeared in the dock before Chief Justice David Malcolm = to=20 learn whether she would go to jail for the events of June 17 last year. = Six=20 weeks earlier, Bentley had pleaded guilty to attempted murder, largely = to spare=20 her children the trauma of testifying. The prosecution had enlisted a=20 psychiatrist, Dr Adam Brett, who said it was unlikely Effexor played a=20 significant part in her illness; another psychiatrist, Dr David Lord, = said=20 Effexor may well have been "unhelpful", but he was not aware of any = scientific=20 research linking antidepressants to a heightened risk of suicide.

Towards the end of his long summary of the case, Justice Malcolm = uttered a=20 19-word sentence that few in the court had been expecting. "My finding," = he=20 said, "is that on the balance of probability, the medication = substantially=20 contributed to the commission of the offences." Effexor, the judge = ruled, had=20 "gravely impaired" Merrilee Bentley's capacity for rational thought and = action.=20 He imposed a two-year suspended jail sentence and told her she was free = to go=20 home.

The decision was immediately attacked by mental health experts, who = said it=20 would deter depressed people from seeking treatment. Professor Ian = Hickie said=20 defence lawyers had recently devised a "cute trick" of pleading guilty = but=20 blaming antidepressants. But later that night, as Bentley sat alone at = her=20 kitchen table in the bungalow next to her father's house, she was not=20 celebrating. "So, I'm

off drugs and I feel good, but I've got no children," she said, = taking stock=20 of the ironies of her case. "And I've got a libido again, but I've got = no=20 husband." She laughed bitterly.

"It's like you have to lose everything."

Since late last year, Bentley has been seeing a counsellor, who has = finally=20 helped her recognise the warping effects that losing her mother exerted = on her=20 personality. She believes the malign influence of antidepressants = twisted that=20 into a delusion that it was better to kill her children than to have = them suffer=20 the same abandonment. All of which leads to the cruellest irony of all: = welfare=20 authorities are already preparing to launch court proceedings to have = her three=20 children separated from her permanently and placed in foster care.

So Bentley is facing more stress, another court battle, all of it = while under=20 the cloud of a suspended jail term which can be enacted if she puts a = foot=20 wrong. There will be bad days, when the spectre of depression hovers. = She says=20 she's strong enough to get through it without drugs. But her court = supervision=20 order stipulates that she must comply with any treatment her = psychiatrist=20 suggests.

"I would be really afraid if someone said to me, 'You have to take = this=20 medication,'" she says. "Throughout all this, there was never an offer = from a=20 psychiatrist to work with me on the issues I was dealing with. It seems = all I=20 was ever offered was medication. And to me, medication is too = easy."

Top=20 of Page

More news

Bun fight sparks Mac attack
With fat controllers everywhere, it should be easy to = fight the=20 good fight
Patients forced to wait for life-saving = surgery

National

Hill=20 to formalise 'Son of Star Wars' commitment=20
Father=20 runs over toddler in driveway=20
Howard=20 appalled by Saudi beheading=20
Australia=20 to commit to 'Son of Star Wars'=20
WA=20 raids seize Chinese fossils worth millions=20
Risks=20 to children charted=20
Mine=20 safety job questioned=20
Parents=20 get say on principals' performance=20
The=20 wild's not our oyster any more=20
Fat=20 wad of dollars in school fund-raisers

World

Putin=20 claims Iraq planned to attack US=20
Hacker=20 hits sensitive South Korean targets=20
Website=20 statement rejects Muqrin's death

Opinion

Poor=20 countries need to form a trade bloc=20
With=20 fat controllers everywhere, it should be easy to fight the good = fight=20
Just=20 parents saying no? Fat chance