Case presentation
The patient was a 23-year-old Han Chinese woman hospitalised twice to treat her addiction to zolpidem. Six years ago, when the patient had poor sleep due to the pressure of school examinations, her psychiatrist prescribed zolpidem (Stilnox) 5 mg/night for bedtime insomnia. The patient accidentally discovered that higher doses of zolpidem could induce a state of euphoria.
Seeking more of the euphoric effects, she took the drug daily, increasing the dosage over time. While 30–40 mg of zolpidem triggered a feeling of pleasure, higher doses induced a sense of euphoria, which was more likely to occur if taken on an empty stomach. This feeling would appear approximately 20 min after ingestion and last for several hours. The patient felt joyfully wild during the euphoric period and experienced increased activity, incessant talking, reckless behaviour and grandiosity.
Taken without self-control, the increasing amounts of zolpidem disrupted her circadian rhythm; she remained awake and ‘high’ throughout the night, carrying out various activities, boasting while calling her friends, playing online games and so forth. In addition,the patient experimented with other sleeping pills, such eszopiclone, alprazolam, lorazepam, diazepam and so on, but none of them induced similar euphoric feelings.
One year ago, the patient developed withdrawal symptoms and increased her zolpidem intake to 400 mg/day. At this point, she had to spend much time and money procuring the additional zolpidem drugs. Unable to get a sufficient supply from hospital pharmacies, the patient bought the medication at high prices online, often borrowing money from friends and stealing her parents’ credit cards.
The patient was hospitalised for the first time in August 2019 to treat zolpidem addiction because of her impaired memory. During the 14-day hospitalisation, diazepam—the selected replacement drug for treatment—was progressively reduced from 30 mg/day to its discontinuation. Two weeks after hospital discharge, the patient again took zolpidem and rapidly increased thedose to 200 mg/day.
By June 2020, the patient showed persistent depressive mood and had made some suicide attempts. She began smoking and soon consumed 40 cigarettes/day, simultaneously raising her zolpidem intake to 800 mg/day. Unable to obtain enough zolpidem, the patient substituted diazepam every 4 or 5 days, taking approximately 20 mg of diazepam three to four times per day but still manifesting withdrawal symptoms of zolpidem during this period.
In November 2020, she was hospitalised for suicidal risk and massive zolpidem intake. Three days before admission, the patient had taken zolpidem 1400 mg and alprazolam 4.8 mg. The patient had no other substance abuse history, physical disease history or family history of mental illness or substance abuse (For timeline, see figure 1).
ඉතිං බලපංකො..හරිනේ ඉතිං 5mg කියන්නේ පෙත්තෙන් බාගයක් නේ..ඩොකා ඒත් කිව්වා දිගටම බොන්න ඵපා කියලත්..මම සතියට 2පාරක් වගේ තමා ගන්නේ ඒකත් අනික් දවස්වලට නින්ද ගියේම නැත්නම් විතරයි...මාත් පුදුම වුනේ ඒකයි අරූ 10mg ගත්තා කිව්වම.. ත්රෙඩ් ඵක දාපු කෙනානම් ඉතිං ඔයිට වඩා ඒවත් ගහන නිසා ඵයාට ඕක 50mg ගැහුවට අවුලක් නැතුව අැති..
