Bitter Pills

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elbourne's Rebekah Beddoe had just landed a good job in a computer company when, in late 1998, she found out she was pregnant. While the news threw her, her boss helped out by granting her a stint of maternity leave that she wasn't strictly entitled to. "Things were looking fantastic at that point," she says. She figured she'd spend six months at home, put her baby in daycare, and get back to work. But soon after Jemima's birth, "I realized I'd been living in a dream world." Jemima cried constantly and screamed in cafés when her mother tried to catch up with friends. Confined to a small apartment, worn down by lack of sleep and feeling inadequate and disillusioned, Beddoe visited a G.P., who suspected postnatal depression and handed her a trial pack of Zoloft. "His words to me were, 'They're completely safe, very effective and only work on people with depression.' If he were to take them, he said, they'd do nothing because they just correct chemical imbalance."

Beddoe didn't like the idea of going on drugs and decided not to take them. She checked in to the mother-and-baby unit of a private hospital, where staff helped her to settle Jemima. There, after another brief consultation, a psychiatrist diagnosed Beddoe with postnatal depression and suggested she start on Zoloft right away. This time, she relented. A week later, she was in hospital, waiting in good spirits for a group-therapy session, when something happened. She suddenly couldn't breathe and her heart was pounding. The walls seemed to be closing in. She thought she was having a heart attack, but a nurse took one look at her, disappeared for a few moments, then returned with a paper bag that she placed over Beddoe's mouth. When Beddoe calmed down, the nurse told her she'd had a panic attack but not to worry - they were common in people with depression. Beddoe's plunge into madness had begun. When a neighbor revved his motorcycle within earshot of a sleeping Jemima, Beddoe flew into a rage, chasing him and screaming profanities. That night, preparing dinner, she used a knife to make shallow cuts in her left forearm, just to see how it felt. Over time her psychiatrist added tranquilizers, an extra antidepressant, lithium and eventually an antipsychotic to Beddoe's diet of drugs. There was also a course of electroconvulsive therapy. But her condition worsened. In 2000 she tried to end her life by overdosing on sleeping pills, the first of four such attempts. At her mother's urging she switched psychiatrists, but after stripping back her regimen to a single drug, Prozac, the new doctor gradually built it up again. Beddoe developed akathisia, which she describes "as a horrible energy that fills you with angst and dread and propels you to move about constantly." Akathisia can be a manifestation of SSRI sensitivity, and "it's psychiatry's dirty little secret," says skeptic Lucire. But Beddoe's psychiatrist saw it as just another symptom of his patient's illness.

How rare are cases like Beddoe's? "We see them quite often," says N.S.W. University's Parker, a psychiatrist for 30 years and director of the Black Dog Institute, a not-for-profit research, educational and clinical body specializing in mood disorders. "We see depressed people who've been undertreated and others whose illness is not quintessentially biological," yet their treatment has amounted to "the relentless pursuit of one physical treatment after another." Parker's experience is that, shortly after starting a course of SSRIs, about 7% of patients feel agitation ranging from moderate to profound, while an additional 1% or fewer show psychotic symptoms. "In my view a serotonergic reaction is a true phenomenon," he says, "and we need to be absolutely aware of it. But it doesn't stop me from prescribing." He starts his patients on low doses and warns them about what they might feel when they start taking the drugs (and that they might have symptoms when they go off them). And this is all that many SSRI critics ask of doctors: continue to prescribe the drugs when absolutely necessary, they say, but don't pretend they're as harmless as sweets.