In her most psychotic state, Cheryl heard threatening voices. Faces seen in the trees seemed to laugh at her. While driving one night, she thought a man stepped out in front of her car and she swerved, crashing into a post. This all started in 1989, when after Cheryl's son was born she slipped into a post-partum depression.
"My mind raced with intruding thoughts about killing myself," said the West Coast businesswoman, who did not want her last name used. "I rushed to the kitchen to draw knives, and would catch myself."
Over 13 years Cheryl was hospitalized and treated with antidepressants and hormones, but nothing worked until she entered a clinical trial for a controversial drug that helped lift her out of the darkness: the abortion drug RU-486.
Now, at 53, she illicitly buys the drug from distributors in Asia, traveling two times a year to stockpile 3,000 tablets at a time, at a cost of approximately $10,000.
RU-486 has had a charged history because of the abortion debate. Many doctors are skeptical of the clinical trials on the drug, and worry about unproven benefits and potential side effects, including abortion.
The drug, a synthetic steroid compound known as mifepristone, is known as RU-486 in Europe, and marketed as Mifeprex in the United States. In combination with misoprostol, the drug was used in 161,000 medical abortions in the United States last year, according to the Guttmacher Institute.
When used under doctor supervision, the drug has a strong safety record. Common side effects are vaginal bleeding and cramping, nausea and vomiting, as well as a small incidence of pelvic inflammatory disease, which may be less likely in men or non-pregnant women.
In a highly publicized incident in 2004, the FDA issued a warning about the risk of infection after a California woman died after taking the drug to terminate a pregnancy.
But in clinical trials over the last decade, researchers have been using the drug to treat psychotic depression, a terrifying form of depression that carries a high suicide risk, and for which there are few sure-fire cures.
They say the drug acts on the brain's receptors for cortisol, the so-called "stress hormone."
Andrea Yates, the mother who drowned her five children in Texas in 2001, likely suffered from psychotic depression, believing that she was a bad mother and that her children were "doomed to burn in the fires of hell."
Published studies on RU-486, two of them run by Corcept Therapeutics, the drug's manufacturer, have shown weak short-term effects. But some doctors say this drug, or other cortisol-related interventions, and even related theories on inflammation and depression, may eventually show promise.
The Food and Drug Administration will review an application for use as a treatment for psychotic depression at the end of the year.
"When people are stressed, we know that there is an increase in inflammation and cortisol," said Kenneth Robbins, medical director of psychiatry at Stoughton Hospital and professor of psychiatry at the University of Wisconsin. "I think this hypothesis is really interesting, and has to do with inflammation and cortisol metabolism, and treating inflammation somehow improves mood."
Other studies have shown an association between depression and inflammation in the area of the brain that controls mood, he said.