[SSRI-Research] Judge rules: Effexor substantially contributed to the commission of the offences

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JustSayNo

Mon, 21 Jun 2004 21:33:59 -0700 (PDT)

[sSRI-Research] Judge rules: Effexor substantially contributed to the

commission of the offences

 

http://smh.com.au/articles/2004/06/19/1087595776529.html?oneclick=true

 

A bitter pill

 

They were lauded as the miracle drugs: a new generation of antidepressants that

promised to make us " better than well " . But for Merrilee Bentley they did the

opposite: her spiral into darkness ended when she tried to kill herself and her

two daughters. Richard Guilliatt reports.

 

The day Merrilee Bentley tried to kill herself and her two daughters began like

every other day she endured last winter. Some time around 8am, Bentley awoke in

a fog of fatigue and listlessness, shuffling into the kitchen of the small

bungalow she shared with her husband, Mat, in the orchard country south of

Perth. Her 10-year-old daughter Ally was getting ready for school, two-year-old

Lauren was awake, and Mat was preparing to leave for his job at a local sawmill.

Bentley tried to help with breakfast, but felt overwhelmed by exhaustion. She

thought about asking Mat to stay home from work, but money was tight, so she let

the idea pass. In the kitchen, she made herself a cup of coffee and swallowed

two tablets of Effexor, the antidepressant she'd been taking in ever-increasing

doses for six months.

 

At 31, Bentley was in the grip of a fearsome depressive spiral. The previous

year she had tried to kill herself four times, twice by hanging. Each new day

now brought incessant thoughts of suicide, as if a malignant growth had taken

root in her mind. On this particular day, her social worker was unavailable and

she began to feel increasingly agitated. Almost as if she were fleeing her own

thoughts, Bentley grabbed the car keys and resolved to drive 220 kilometres

north-west to Perth. She put Lauren in the car, picked up Ally from school, and

was heading west to Bunbury when a familiar idea began gnawing at her.

 

" I was thinking, 'No one cares. No one's there. I'd be better off dead.' " A year

later, Bentley still cannot recall the events of that day without sobbing. " And

because my children were with me, they kind of came into the argument in my

head: should I just turn around and take them somewhere, or should they come

with me? And the argument in my head was, 'No, don't let them be without a

mother.' So I convinced myself to take them with me. "

 

After driving into Bunbury, Bentley hocked her wedding ring for some cash and

bought a length of rubber hose. At a Hungry Jack's restaurant, she sat watching

her children in the playground while she composed a letter to them, expressing

her sorrow for what she was about to do. Putting the girls back in the car, she

drove north for nearly an hour and pulled over at a wayside stop off the highway

near Waroona. She ran the hose from the exhaust pipe into the back window,

telling the girls it would warm the car, and sat in the back with them,

listening to the radio. But the hose was kinked, and nothing happened, so

Bentley tried to shake herself free of her death wish and drove on towards

Perth.

 

" I stopped at a petrol station, and Ally asked for a bottle of Fanta. And I

looked at the bottle and thought, 'That'll fit on the exhaust pipe.' And all

these thoughts came back - just on and on and on and on. I bought some tape and

I bought scissors, and I cut the bottle and put it on the pipe. I found another

car park and I put the bottle on the exhaust and put the hose in the window. I

could smell the fumes a lot more.

 

" I really thought you just fell asleep. We were sitting in the back seat, and

after about 10 minutes Ally said, 'It stinks.' I said, 'Just rest,' still

convincing myself I had to do this. Then my eyes started to sting a bit, and I

was getting confused. And Ally was starting to hold her nose and Lauren was

starting to cry and get upset. Ally said, 'It's horrible,' and I said, 'Well,

get in the front.' So she got in the front seat for about 30 seconds and I saw

her going towards the door and I said, 'Just get out,' as she was opening the

door.

 

" Then I got really angry with myself, because although I knew what I was doing,

I didn't actually want to cause them any pain. I didn't want to hurt them. So I

opened the back door, sat Lauren on the back seat, and I went and got 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

fragile marriage collapsed, her children were taken away from her, and she found

herself huddling in a concrete police cell in Bunbury charged with attempted

murder, before being sent to Graylands psychiatric hospital. But amid all this

trauma, separated from everyone she knew, she also came to a pivotal decision:

on July 5, a week after her antidepressant dosage was increased to 450mg a day,

Bentley stopped taking Effexor. Within days, she began to feel better. Her

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, and

last month the Chief Justice of Western Australia came to much the same

conclusion. The implications of that carry far beyond Bentley's life, because

her case is simply the latest in a succession of tragedies that have raised

persistent and disturbing questions about the " miracle " of modern

antidepressants.

 

In the history of drug-induced euphoria, there has never been anything quite

like the Prozac phenomenon. Launched by Eli Lilly in 1988, this tiny pill came

to embody the seductive promise that science had found the key to human

happiness. Prozac regulated the brain's serotonin levels and thus, it was

claimed, made people " better than well " . It became a cultural touchstone -

dissected on talk shows, emblazoned on countless magazine covers, name-checked

in pop songs and movie titles, extolled in countless best-selling books. It

spawned its own buzz-phrases - Prozac Nation, Listening to Prozac - and reaped

billions of dollars for the pharmaceutical industry, which quickly launched a

range of copycat drugs like Zoloft, Aropax, Paxil and Luvox.

 

These drugs, the selective serotonin reuptake inhibitors (SSRIs), were said 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 of people who had experienced the " Prozac miracle " were shadowed by

other stories from people who underwent bizarre transformations, becoming

agitated, aggressive, emotionally blunted and suicidal.

 

A series of violent murders and suicides linked to the drugs sparked alarm in

the early 1990s, but the drug companies successfully fought off lawsuits, and

the US Food and Drug Administration (FDA) reviewed the evidence and pronounced

them safe.

 

By the late 1990s, however, several drug companies had been forced to hand over

their internal records to personal injury lawyers, and it became clear they had

suppressed damaging data. In 2001, a Wisconsin jury ruled that the SSRI drug

Paxil had caused 60-year-old Donald Schell to kill his wife, daughter,

granddaughter and himself in a shooting frenzy. Three weeks earlier, a NSW

Supreme Court judge 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, British health officials last year banned the use of all SSRIs except

Prozac for treating under-18-year-olds, revealing that clinical trial data on

Paxil - which the drug company GlaxoSmithKline had suppressed - showed an

increased risk of suicidal behaviour for minors.

 

According to the Los Angeles Times, an unreleased report last year by the

FDA came to very similar conclusions, in particular about Paxil and Effexor.

US health authorities are now reviewing all data on SSRIs, and many drug

experts 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.

Healy has worked as a consultant to many of the major drug companies and

written several books on the history of psychiatric medicine. He remains a

firm advocate of drug treatment for depression and thinks SSRIs work well

for many people. But he has become the drug industry's worst nightmare: an

authoritative expert who believes SSRIs are also killing thousands of people

every year.

 

In his latest book, Let Them Eat Prozac, Healy uses drug company research

data and his own expertise to argue that SSRIs may induce suicidal thoughts

in as many as 1 per cent of patients. (If that sounds like fairly small

odds, consider that 50 million prescriptions for these drugs have been

written in 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 sanitising the data. And, in doing so, they enlisted the help of

many scientists who accepted industry money to conduct research, or attached

their names to ghost-written research papers.

 

A case in point is Effexor, the drug Merrilee Bentley was taking when she

tried to kill her children. Healy recalls that several years ago, he was

invited to a luxury convention centre on the Californian coast where Wyeth

Pharmaceuticals, Effexor's manufacturer, was sponsoring a conference on

depression. As part of the deal, Wyeth had paid ghost writers to draft a

" David Healy " paper which he could present on the difficulties of achieving

" full remission " of depression - a phrase which happily coincided with

Wyeth's marketing campaign for Effexor. Healy declined the offer, but the

article subsequently appeared in the Journal of Psychiatry and Neuroscience,

under another researcher's name.

 

Healy's outspokenness has incurred the full wrath of mainstream psychiatry.

At a recent symposium on antidepressants in Sydney, one psychiatrist, Dr

Olav Nielssen, dismissed Healy's work in a few sentences and said " there's a

word in Yiddish I could use to describe him " . Professor Ian Hickie, director

of the Brain and Mind Research Institute at the University of Sydney, says

Healy is a " hired gun " who uses selective research to help people sue drug

companies. 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 SSRI drugs. Furthermore, he says, doctors are extensively educated

on the side effects of these drugs and appropriate warnings for patients.

 

That wasn't the case, however, for Merrilee Bentley. In all her years

seeking treatment for depression, Bentley cannot remember a doctor ever

warning her that antidepressants might worsen suicidal impulses.

 

She was first diagnosed with depression as a child, after her mother left

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 emotionally vulnerable of the sisters, and fear of rejection became a

recurring motif in her life.

 

At 16, she left home, eventually moving in with her biological mother in

Bunbury, 180 kilometres south of Perth. It was a fraught relationship,

however, and the events of 1978 were never really resolved. By 22, she had a

son, Carl, and a daughter, Ally, with her then boyfriend, Daniel. But Daniel

became violent and she moved 50 kilometres inland to Collie, struggling to

cope with life as a single mother.

 

" I'd say that's when it started, " she recalls, sitting in the lounge room of

her father and stepmother's home in bushland near Collie, on a late May

afternoon. " Being a single mum, being lonely, meeting guys who just wanted

to have sex with you. " She sighs. " Just longing to be loved. In 1995, I

tried Prozac, which really didn't agree with me - it made me a bit

aggressive, a bit angry. "

 

It's almost a year since Bentley tried to kill herself and her children, and

for all the tears and sorrow that punctuate her conversation, it's clear she

has undergone a remarkable transformation. A year ago, she weighed 76

kilograms and was " a walking vegetable " . Today, she is 20 kilos lighter and

has been drug-free since September. The dark circles under her eyes hint at

the difficulties she is still grappling with: her children have been in the

care of various relatives since June 2003 and she is not allowed to see them

without supervision; she has separated from her husband and lives in a small

bungalow near her father's house; she has pleaded guilty to four counts of

attempted murder (two for each child) and is scheduled to be sentenced by

the WA Chief Justice the day after our interview. But despite it all, she

talks with resolute candour about the calamitous events of the past year.

 

Like so many people suffering depression and stress, Bentley turned to her

local doctor for help and was handed a packet of pills. After Prozac she

tried Zoloft, but it made her nauseous. In August 1996, she met her current

husband, Mat Bentley, who was six years her junior, but the relationship was

stressed from the beginning by the disapproval of his family. Acutely

sensitive to the smallest rejection, Bentley first had suicidal thoughts

after an argument with Mat in early 1998, around the time she was first

prescribed Aropax. Whether the suicidal thoughts followed the Aropax, or

vice versa, is unclear.

 

It's this very issue that sparks the fiercest arguments in the antidepressant

debate. Depressed people often feel suicidal, so drug companies have long argued

that the illness, not the drugs, is the problem. Critics like David Healy, on

the other hand, say SSRIs can trigger the very symptoms they're supposed to

treat, which makes detecting their side effects a nightmare. It's a circular

argument which is almost impossible to resolve.

 

What's indisputable about 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

surrounding her impending marriage to her boyfriend, her GP put her back on

Aropax. Five weeks later she became suicidal and was hospitalised. Things

stabilised after she fell pregnant with her third child, Lauren, but in

mid-2002 her condition again nosedived. Her son Carl had to move to his

paternal grandparents' home in Bunbury for schooling reasons; money was so

tight the Bentleys had been forced to rent out their house in Collie and

move into the bungalow on Philip Wright's property with the two girls; and

Bentley had become overweight from a thyroid problem.

 

In May 2002, she attempted an overdose of Aropax, a futile act which

suggests how little she had been told about the drug (death by SSRI overdose

is virtually impossible). In response, doctors doubled her dosage. Some

months later, she tried to hang herself in her father's shed after an

argument with Mat, only to be discovered by a friend.

 

There was a pattern to these incidents, one of extreme overreaction to

normal life stresses. In the latter half of 2002, Bentley's grandmother died

and Lauren was burned by a scalding cup of coffee which the toddler tipped

off a bench. In November, Bentley again attempted an overdose and was rushed

to Collie Hospital by her father. Absconding from the hospital, she wandered

around Collie barefoot before calling the police and being taken to the

psychiatric ward of Bentley Hospital in Perth. There she took the cord out

of her pants and tried to hang herself in her room.

 

" I was in there for ... I don't know how long, perhaps a week, " she recalls.

" Don't remember. And during that time they changed me from Aropax to

Effexor. " A psychiatrist's report - remarkably, Bentley says this was the

first time she was referred to a psychiatrist - noted an improvement under

Effexor, so the dosage was doubled from 75mg to 150mg after she was released

from hospital. By January last year she was at home and on 300mg a day.

Mat Bentley recalls watching his wife get worse with each increase in dose.

" It never improved, " he says. " She was more on edge, doing less around the

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

previously been intermittent surged in strength and frequency. Each increase

in dosage induced a zombie-like state for a week, followed by overwhelming

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

nothing. Nothing would cheer me up.

 

I'd get agitated easily, fly off the handle easily, at other times be curled

up in a ball crying for nothing major. My mental fixation at the time was

death, and that's all I thought about. " Inside her head, she says, was a

battle between her rational self and an irrational other who promised that

suicide would bring relief.

 

" I went to my GP in March and told him, 'I think about suicide all day,

every day - even on a good day.' I really think he should have known

something was wrong then. But he let me walk out the door. " (The doctor's

notes record her condition as " going okay, mildly suicidal thoughts " .) It

took another three months before Bentley finally succumbed, in that car park

on the highway north of Bunbury on June 17, to her obsessional impulse to

kill herself. In the distorted thinking of that moment, she argued that by

taking her children with 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 had done. She made full admissions to a social worker, was briefly

hospitalised, and on June 24 her daughters were taken away by welfare

officers. On a Saturday afternoon 10 days later, police met her at her

mother's house in Collie and told her she was to be charged with four counts

of attempted murder. After driving her north to the scene of her crime and

asking her to re-enact the events for a video camera, they took her to

Bunbury lock-up to be strip-searched and put on suicide watch in a cell.

 

" Then I crashed. I was sitting on the floor, rocking, and I called them and

said if they didn't get me to a doctor I was going to kill myself. " It was

only then, when Bentley realised she had nothing left to lose, that she

resolved to try to wrest back control of her life.

 

A week earlier, a psychiatrist had upped her dosage of Effexor to 450mg -

twice the recommended maximum for mild depression. But only a few days after

that, she'd read an article in The West Australian newspaper that revealed

something no one had ever told her - that antidepressants can sometimes trigger

mood disorders. On the day she was arrested, Bentley had taken only one Effexor

instead of three. By the following day, when police transferred her to the

psychiatric ward of Graylands Hospital, she'd stopped taking Effexor completely.

Appearing in Bunbury courthouse to face her charges 24 hours later, Bentley was

a shivering mess, convulsed by nausea as her body went cold turkey.

 

To ease the symptoms, she began taking a low dose, and by Thursday she was in

her room at Graylands experiencing an " almost indescribable " change.

" I have energy and can think more clearly and the suicidal thoughts that

plagued me on a daily basis have now been replaced by the ability to think

more objectively and positively, " she wrote in a notebook. " It is truly an

amazing feeling. " Suddenly it seemed clear that the force which had pulled

her inexorably towards suicide was not her depression, but the drugs - a

realisation that triggered an understandable anger. " I feel, " she wrote,

" that the doctors, psychiatrists and other medical and mental health

'professionals' that I have spoken to since my first suicide attempt have

completely failed me. "

 

Last year, 10.1 million antidepressant prescriptions were handed out in

Australia, according to the Health Insurance Commission, nearly double the

amount in 1996. To mainstream psychiatrists, this is a heartening sign that

the 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 routinely prescribed for conditions such as hyperactivity, anorexia and

stress. A quarter of a million prescriptions last year went to children and

adolescents, 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

Women's and Children's Hospital in Adelaide, has voiced concern about the

over-prescription of these drugs and their possible links with suicidal

behaviour. And Dr Yolande Lucire, a Sydney forensic psychiatrist, told a

recent meeting of forensic scientists that she has observed significant

numbers of people entering hospital with SSRI-induced mania and psychosis.

 

On a chilly Wednesday morning at the Supreme Court in Perth last month,

Merrilee Bentley appeared in the dock before Chief Justice David Malcolm to

learn whether she would go to jail for the events of June 17 last year. Six

weeks earlier, Bentley had pleaded guilty to attempted murder, largely to

spare her children the trauma of testifying. The prosecution had enlisted a

psychiatrist, Dr Adam Brett, who said it was unlikely Effexor played a

significant part in her illness; another psychiatrist, Dr David Lord, said

Effexor may well have been " unhelpful " , but he was not aware of any

scientific research linking antidepressants to a heightened risk of suicide.

 

Towards the end of his long summary of the case, Justice Malcolm uttered a

19-word sentence that few in the court had been expecting. " My finding, " he

said, " is that on the balance of probability, the medication substantially

contributed to the commission of the offences. " Effexor, the judge ruled,

had " gravely impaired " Merrilee Bentley's capacity for rational thought and

action. He imposed a two-year suspended jail sentence and told her she was

free to go home.

 

The decision was immediately attacked by mental health experts, who said it

would deter depressed people from seeking treatment. Professor Ian Hickie

said defence lawyers had recently devised a " cute trick " of pleading guilty

but blaming antidepressants. But later that night, as Bentley sat alone at

her kitchen table in the bungalow next to her father's house, she was not

celebrating. " So, I'm off drugs and I feel good, but I've got no children, " she

said, taking stock of the ironies of her case. " And I've got a libido again, but

I've got no 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

helped her recognise the warping effects that losing her mother exerted on

her personality. She believes the malign influence of antidepressants

twisted that into a delusion that it was better to kill her children than to

have them suffer the same abandonment. All of which leads to the cruellest

irony of all: welfare authorities are already preparing to launch court

proceedings to have her three children separated from her permanently and

placed in foster care.

 

So Bentley is facing more stress, another court battle, all of it while

under the cloud of a suspended jail term which can be enacted if she puts a

foot wrong. There will be bad days, when the spectre of depression hovers.

She says she's strong enough to get through it without drugs. But her court

supervision order stipulates that she must comply with any treatment her

psychiatrist suggests.

 

" I would be really afraid if someone said to me, 'You have to take this

medication,' " she says. " Throughout all this, there was never an offer from

a psychiatrist to work with me on the issues I was dealing with. It seems

all I was ever offered was medication. And to me, medication is too easy. "

 

 

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