Zolpidem-induced Hypomanic State and Associated SPECT Findings: One Case Report

I. Chih Cheng, Mei-Chih Tseng, Yue Joe Lee, Ming Been Lee

研究成果: 雜誌貢獻文章同行評審


Zolpidem is a short-acting, nonbenzodiazepine hypnotic and used for treatment of insomnia. Recently, there are some reports of delirium, amnesia, psychotic symptoms and somnambulism associated with zolpidem; however, to our knowledge, zolpidem-induced hypomanic state has not been reported before. A case report of zolpidem-induced hypomanic state will be presented here. Initially, because of depression-related insomnia, in addition to antidepressant fluvoxamine, the patient took zolpidem. Her family incidentally observed that depressed mood improved transiently after taking zolpidem 5-10 mg. During hospitalization, her mood became more euphoric, and the amount of verbal output and activity level also increased half an hour after zolpidem was taken. Its effectiveness lasted for about eight hours. For further investigation, SPECT study was done twice, respectively, before and one hour after taking zolpidem. On the day of exam, half an hour after taking zolpidem 10 mg, she was noted to have elated and euphoric mood, hyperactivity, hypertalkativity, and distractible attention with clear orientation to time, place and person. In general, her clinical feature was assessed as hypomanic state. Although both results of SPECT study revealed hypoperfusion at bifrontal cerebral region, it was quantitatively more hypoperfusion after a single 10-mg dose of zolpidem. Three weeks after regular treatment with fluvoxamine, her depressed symptoms improved gradually. Now, her mood could keep euthymic as premorbidly. Five months later, her depressive syndrome resolved completely. Repeated SPECT study showed previous hypoperfusion at bifrontal cerebral region had improved partially. Zolpidem-induced hypomanic state in our case implies GABA might be associated with pharmacological mechanism of treatment effect on mood disorder. Our report also demonstrated SPECT findings in different mood status of the depressed patient.
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出版狀態已發佈 - 9月 1 2002