Zolpidem-induced Hallucinations: A Brief Case Report from the Indian Subcontinent
A 20-year-old female patient visited our psychiatric clinic with sadness of mood and irritable behavior for 4 months. The onset of illness was subacute without any precipitating factors. Her family members also noticed a change in her behavior. Now she would remain worried and preoccupied with thoughts of her marital life most of the time in a day with gradual loss of interest in pleasurable as well as routine activities. She would feel low, gloomy, and fatigued all the day. She had to push herself to go to office and would not take much interest in grooming herself now. She would become easily irritable and falls into arguments frequently. Many a times she would become abusive-aggressive and had harmed herself. Once she attempted suicide after having an argument with her husband. Her biological functions were disturbed and her risk assessment for suicide revealed a high score.\nHer detailed routine and special investigations ruled out any organicity. She was diagnosed as a case of major depressive disorder and was put on paroxetine 12.5 mg twice a day and zolpidem 10 mg at bed time for sleep. Next day, she reported with complaints of experiencing dream-like pleasurable state in which there was Lilliputian like visual and elementary auditory hallucinations after half an hour of ingestion of zolpidem. She slept comfortably 15-20 minutes after the episode. She had partial memory for this phenomenon in the morning.\nThe patient was thoroughly assessed and was advised for hospitalization. Her treatment modalities were altered. Zolpidem was replaced with alprazolam 0.25 and the rest of the medications were unchanged. She remained free of any psychotic phenomenon in further nights. She underwent four psychoeducation sessions and was provided supportive psychotherapy. She showed improvement with treatment and her depressive symptomatology was lessened. The mood disturbances observed in the patient slowly over the next 3-month treatment were replaced by euthymia most of the time. The patient started doing her routine activities and no any hallucinations were reported by the patient in her follow-up.