Bernie and Ruth Madoff's alleged suicide attempt on Christmas Eve in 2008, just after their sons had turned over the Ponzi schemer and his wife to federal authorities, appears to have been either half-hearted or ill-planned if true, according to overdose experts.
Of all the drugs they chose for their suicide pact, the sleeping medication Ambien and anti-anxiety pill Klonopin are among the safest drugs around, if not taken in combination with alcohol or other more powerful drugs that could paralyze respiration.
Ambien is a brand name for zolpidem, which is in a group of drugs related to the benzodiazepines and acts in a similar way. Klonopin is a brand name for clonazepam, which is one of the benzodiazepines.
Taken by mouth, alone, by an otherwise-healthy adult who's used them before, neither drug is likely to cause death. No one knows for sure, but the Madoffs may have been naïve about the strength of the drugs -- or they never intended to die.
"We see plenty of people who want attention and maybe are crying for help take overdoses of a pretty wimpy drug and get all the drama around them," said Dr. Marcel J. Casavant, medical director of the Central Ohio Poison Center and clinical professor of toxicology at The Ohio State University Colleges of Medicine and Pharmacy.
"This pattern is very common for somebody to do something they think is suicidal and then to wake up the next day," he said. "Of course, we don't know if they are telling the truth or not."
Ruth Madoff, now 70, told Morely Safer of "60 Minutes" that she and her husband, now 73, made a pact to kill themselves after the scandal that robbed investors of millions broke.
"I don't know whose idea it was, but we decided to kill ourselves because it was so horrendous what was happening," she told CBS. "We had terrible phone calls. Hate mail, just beyond anything and I said, 'I just can't go on anymore.'"
She said she didn't mix the pills with alcohol because she was afraid they would vomit the pills back up.
"I took what we had, he took more," she said. "We took pills and woke up the next day. ... It was very impulsive and I am glad we woke up."
Casavant said had they taken enough drugs with alcohol, they may well have died.
"This is a typical pattern when people feel alone and trapped in a situational crisis where they are publicly humiliated and shamed and desperate and facing incarceration," said John Draper, director of the National Suicide Prevention Lifeline. "Those all add up to feeling suicidal."
Still, Draper said, people in despair can still feel "ambivalent" about killing themselves. "The emergency rooms are filled with stories of people who survive attempts and later are glad they survived, even though they thought at the time they wanted to die."
Judy Kuriansky, a psychologist and professor at Columbia University's Teachers College, said the timing of the Madoff's suicide confession, three years later, was suspicious.
"Why tell now?" she asked. "I think it's a play for sympathy and book sales to reveal it now -- though it makes sense to think of ending it all because of the humiliation and really no way out."
If the Madoffs really wanted to die, they could have succeeded, according to Kuriansky.
"People who are smart enough to con millions of colleagues out of so much money ... are smart enough to know how many sleeping pills to take to insure not waking up."
Ruth Madoff added that she didn't even know if they took the Klonopin or not.
"No doubt the Madoffs are both depressed," said Kuriansky. "Their son Marc committed suicide in his Manhattan loft on the second anniversary of his father's arrest."
The younger Madoff hung himself from a living room beam with a dog leash while his son slept in a nearby room. The first attempt did not work, according to reports, as a broken vacuum cleaner cord was found nearby.
"Narcissistic and powerful people in the high life, like the Madoffs, who fall from grace and their position, suffer tremendous humiliation, which can add to suicidal ideation," said Kuriansky.
Madoffs May Have Been Ignorant
Experts say that most people are unfamiliar with drugs and which medications and doses would really kill them. The Madoffs could have been ignorant.
"We see people who take acetominophin (Tylenol) and end up in the hospital for two or three days getting life-saving treatment, and [they] didn't think it could have been that dangerous," said Casavant.
"Some people wake up surprised they are awake and think this should have killed them," he said. "And sometimes they are disappointed and mad at me for keeping life going."
Paul Doering, co-director of the Drug Information and Pharmacy Resource Center at the University of Florida, agreed that the average person "has no idea" how dangerous or toxic a drug might be.
"I have carried a beeper around with me for overdose patients and you get all types," he said. "Someone decides to end it all with 100 [tablets] of amoxicillin [an antibiotic] which won't kill you but probably [will] make you throw up. Others try to overdose on birth control pills."
Before the advent of newer, safer sleeping medications in 1970, the drugs most often associated with death were barbiturates like Seconal or Nembutal, which had a "narrow measure of safety," according to Doering.
Actresses Marilyn Monroe and Judy Garland overdosed on those drugs. Today, they are used in states that allow physician-assisted suicide and for lethal injections used in the death penalty.
Opioids, such as Ocycontin, can also be dangerous, especially in combination with benzodiazepines and alcohol.
Drug cocktails like these can paralyze "the most primate part of your brain," the respiratory center, said Doering.
Amy Winehouse's death earlier this year was ruled an alcohol overdose -- five times the legal limit -- that caused her breathing to stop.
Benzodiazepines have had a much greater safety record. Valium, the first member of the benzodiazepine family, was approved by the FDA in 1963 as a sedative-hypnotic that targets anxiety.
"The idea of any drug is to do all good things and spare the bad things," Doering said. "Sometimes, we can't separate that out. Drugs that relieve allergies give you dry mouth. One of the beautiful things about benzodiazepines is you can take a whole bunch of it and not reach the respiratory center in the brain."
Doering said he had a female patient who took 100 tablets of Valium, each 5 mg. She was "out like a light" for several days, but did not die.
"Benzodiazepines work effectively and wear off in a reasonable period of time with a low risk of overdose," he said. "They are safer in overdose that most medications. You would probably choke on the pill rather than die from the drug itself."
He guessed that with the combination of Ambien and Klonopin, the Madoffs "probably slept well for eight hours."
"If the Madoffs woke up the next day and felt reasonably well, they didn't take a whole lot of it," said Doering. "It's almost impossible to kill yourself on benzodiazepines."
"People shouldn't try to overdose on any meds," he said. "You could be the first one in medical history to die of a single intoxication of Klonopin or Ambien. But when you combine it with other drugs, all bets are off."
As for the Madoffs, "I am not surprised he woke up the next day," said Doering. "He couldn't even get the overdose right."