Complex behaviors related to zolpidem: An analysis of published clinical cases from Taiwan

Objective: Benzodiazepines with a unique chemical structure of three-ring diabenzine can induce the benzodiazepine-gamma aminobutyric acid A receptor complex to produce sedative, anxiolytic, muscle-relaxant, and anticonvulsant effects. But they have serious side effects such as tolerance and withdrawal, memory and performance impairments, and complex behaviors associated with amnesia. Method: We searched zolpidem-related published papers from Taiwan from 2003 to 2011. All bibliographical data of original clinical reports were studied. We focused only on complex behaviors related to zolpidem and not on the symptoms of zolpidem-related addiction, tolerance, and withdrawal. Results: The search in PubMed with the keyword " zolpidem" yielded 729 articles published from 2003 to 2011. Of these, 20 articles were written by Taiwanese author(s). There were 15 case reports and five clinical studies. Besides the symptoms of addiction, tolerance, and withdrawal, these papers describe complex behavioral disturbances, such as performance impairments, behavioral impairment with amnesia, sleepwalking, sleep-related eating disorder, and hallucination and sensory distortion. Conclusion: We have summarized the case reports and clinical studies of zolpidem-related adverse effects published from Taiwan and reviewed concerns about zolpidem's safety that international researchers have been voicing out in recent years. The incidence of those zolpidem-induced complex behaviors is similar to that found in Western countries. Clinicians should therefore use more antidepressants to treat the underlying diseases that present with insomnia (such as major depressive disorder or generalized anxiety disorder).