September 06, 2017, 09:05 AM
rtquigread:http://www.medpagetoday.com/meetingcoverage/apa/45637
I take Ambien for sleep. I believe this is possible. I have cooked, showered, and done other things in the middle of the night that I have no knowledge of until my wife shows me the proof. I have woken up in the garage looking for a wrench in my tool box, I have no idea why I needed a wrench. While the odds are against it, it is possible.
Murder: Another Ambien Side Effect?
www.medpagetoday.com 7 mins read
Action Points
Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
This presentation includes a review of the literature on adverse zolpidem reactions and a presentation of two forensic cases, in which concomitant zolpidem and paroxetine use was associated with the violent killing of a spouse while reportedly being totally or partially amnesiatic.
NEW YORK CITY -- Forensic psychiatrists have found it challenging to unravel the role of zolpidem (Ambien) in several brutal murders committed against loved ones -- and then to persuade attorneys, judges, and juries to take their conclusions seriously.
The cases may be the most extreme examples of an already known side effect of zolpidem -- that, even at recommended doses, people using the drug may get out of bed and do things while still effectively asleep, and don't remember it the next day.
Numerous reports have described people fixing meals, having sex, and even getting into their cars and driving away in the middle of the night, with no later recollection. A few "Ambien zombies" have wrecked their cars and even killed people in accidents.
But in at least three cases, a person with no apparent motive and no history of violence brutally murdered a spouse or close friend in the wee hours after taking more than the recommended dose of zolpidem along with other psychotropic medications.
A forensic psychologist and two psychiatrists who were involved in two of these cases discussed their experiences and how the law is evolving in this area at the American Psychiatric Association's annual meeting here.
Zolpidem was first approved in 1992. In 2007, after reports had piled up describing bizarre and dangerous activities undertaken by patients who had taken either high doses or regular doses in combination with other drugs such as alcohol, the FDA issued a "Dear Doctor" letter warning of "sleep-driving" and other risks.
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The Crimes
The FDA announcements made no mention of murders committed by zolpidem users, but it had to have been aware of at least two of them. They were described in a 2012 paper by psychologist Cheryl Paradis, PsyD, of Marymount Manhattan College and Kings County Hospital, and two psychiatrist colleagues -- Lawrence Siegel, MD, and Stuart Kleinman, MD, of Columbia University. They had worked for the defense teams in those cases and also were the speakers at the APA panel this week.
A third murder linked to zolpidem had been committed in April 2013, just before the agency ordered the new restrictions.
The two cases in the 2012 paper involved a 45-year-old man and a 62-year-old woman, both of whom had taken at least two 10-mg zolpidem pills (the current maximum dosage is 5 mg for women and 10 mg for men) and had received other prescription psychotropic drugs including paroxetine (Paxil) and, in the man's case, quetiapine (Seroquel).
Sometime in the night, these patients got up and killed their spouses. Mr. A, as he was called by Paradis and colleagues, stabbed his wife more that 20 times. Ms. B went into her garage, picked up a metal pipe, and returned to the bedroom where she bludgeoned her husband and then put a plastic bag over his head.
Both Mr. A and Ms. B stayed alone with the bodies for hours, and then seemed glassy-eyed and confused when they finally emerged. They consistently denied any recollection of the events and were initially incredulous that they could have done such things.
Also, in both cases, the perpetrators reported being still sleepless after taking one zolpidem and had therefore taken additional pills.
In the 2013 case, a young man in Littleton, Colo., a suburb of Denver, named Andrew McClay beat his female housemate to death with a hammer. According to news reports, he had taken five zolpidem pills along with whiskey and naproxen. Other aspects of the crime and its aftermath were similar to those in the previous two cases.
Another similarity was that all three ended up criminally convicted. Mr. B was found guilty of second-degree murder at trial, and McClay pleaded guilty to the same charge; both received long prison sentences. Ms. B pled guilty to manslaughter in a deal with prosecutors and served 4-1/2 years before being paroled.
Amnesia and Responsibility
Kleinman told APA attendees that amnesia -- even if a jury can be persuaded that it's genuine -- does not absolve someone of a crime he or she has committed. The fact that a murderer later doesn't remember doing it does not mean that he or she wasn't fully aware of it and its implications at the time, he noted.
But, in some states, murderers can argue that, as a result of some medical condition or medication they were taking, they were not in control of their actions through no fault of their own. It's called "involuntary intoxication" or "automatism" -- although a person may undertake seemingly deliberate acts, he or she may be effectively unconscious and not responsible for those actions.
Kleinman said that is exceedingly hard to do -- it was completely unsuccessful in the case of Mr. A, only partly successful for Ms. B, and untested in McClay's case. His attorney told MedPage Today that she thought they could win an involuntary intoxication acquittal, but McClay was afraid he would be convicted of first-degree murder and accepted the slightly lesser charge.
Siegel, who worked on Mr. A's case, also thought they had a winning argument.
He identified several features of the man's behavior before and after the killing that supported an involuntary intoxication defense.
The man had received electroconvulsive therapy (ECT) 3 days before the crime and it might be argued that it caused his amnesia. ECT is not known to foster sleep-walking or other active but unconscious behaviors, so it would not be a credible defense.
In interviewing Mr. A, Siegel found the man's memory intact right up until the time he took two zolpidem pills the night of the murder, "which is not typical of ECT amnesia," he said.
After the crime, Mr. A remained in the apartment -- which was in his parents' house -- with his wife's bloody body for some 12 hours before stumbling downstairs, talking incoherently and looking "catatonic," his parents said. When interviewed by police shortly afterward, he was still incoherent, which was documented on a videotape.
Siegel retrospectively diagnosed Mr. A with major depression with psychotic features, with his behavior the night of the murder a result of zolpidem combined with his other medications.
Pushback From Prosecutors
However, the psychotic features that were documented prior to the murder -- for example, he had told doctors that an ex-wife was controlling his thoughts through books left in his garage, which he then burned -- helped persuade the jury that he was violence-prone.
The prosecution's psychiatrist agreed with the medical
September 06, 2017, 09:24 AM
RAMIUSI never heard of that sort of thing occurring from cold meds.
In regards to ambien (generic zolipidem), I have no idea how that stuff is still legal.
The countless stories of doing things without remember seems like enough to not prescribe it.
I took ambien for a while and I have a few of those stories...I would wake up and look at my phone to see I had full blown text convos I don't remember having.
The craziest one was when I woke up in a girl's bed. I had no recollection of driving to her house and having sex with her.