Mechanism for Zolpidem Hallucinations / SSRI Interaction?

[blight12]

I hope this is ok or at least interesting for ADD. I couldn't find any previous analysis of this here.
It also is a HR query, as I need to know to avoid this in future, if unhealthy, based on scientific feedback.

I am interested in the mechanism by which hallucinations are caused by Zolpidem. Those that are very similar to those caused by sleep deprivation as well as multi day stimulant binges (shadow people, faces in the dark etc)

I have this article as a source but I struggle to interpret the results: http://www.ncbi.nlm.nih.gov/pubmed/9656974

To clarify, I have been confused for some time about why I would experience vivid (shadow people type) hallucinations where the majority did not report such occurrences.

The above article seems to indicate that this is due to the combination of SSRI's and Zolpidem that causes this, which was my situation when i had the experiences. I found Zolpidem to be very entertaining and recreational during these experiences.

I am now concerned that this is a negative interaction (as is common when SSRI's are one of the factors) and that it might be dangerous to combine the two.

My questions:

1. What exactly is the mechanism by which Zolpidem causes these hallucinations? As I understand it only impacts GABA, or is this incorrect?
2. Is there a danger such as Serotonin Syndrome and what is the interaction with SSRI's (if any)
3. These hallucinations seem to mimic those from sleep deprivation and multi day or high dose stimulant binges. Does the drug somehow mimic the brain state of these situations?

Thank you for your time.

 

[AlphaMethylPhenyl]

I never found Zolpidem to produce hallucinations reminiscent of amphetamine psychosis.

Its combined with SSRIs for millions of people, so I wouldn't worry about it if its per doctor's prescription.

 

[P A]

1. What exactly is the mechanism by which Zolpidem causes these hallucinations? As I understand it only impacts GABA, or is this incorrect?

After a perfunctory scan of the literature, it would seem that your guess is as good as anyone's at this point.

2. Is there a danger such as Serotonin Syndrome and what is the interaction with SSRI's (if any)

Not with zolpidem. The only non-hepatic/non-enzymatic interactions of clinical significance (that I know of) are intensification of visual/proprioceptive disturbances, hallucinations, and compulsive behavior whilst the patient is under the influence of the zolpidem, which intoxication should only last ~2 hours after consumption (i.e., of the zolpidem). In other words, unless you're planning on going to work, doing advanced mathematics, and/or operating heavy machinery under the influence of a sedative-hypnotic drug such as zolpidem, it's nothing to worry about - unless you start sleep-driving or some shit, in which case it is something to worry about, implying that you should ditch the zolpidem for something less groovy like, say, a benzo.

3. These hallucinations seem to mimic those from sleep deprivation and multi day or high dose stimulant binges. Does the drug somehow mimic the brain state of these situations?

You might be on to something. My bet is on disinhibition of serotonergic neurons somewhere in the cortex, which disinhibition could share a few key neurochemical features with other sleep deprivation-like states.

Thank you for your time.

My pleasure.

 

[sekio]

I always figured zolpidem produces "hallucinations" by the same mechanism that muscimol does, from selective hyperactivation of (inhibitory) GABA-a receptors probably responsible for what we consider "sanity" and "conciousness", producing a sleep-like delerium, or a sort of lucid dream. It's the most rational explanation I can come up with for why the Z-drugs are really the only class of "GABA sedatives" that produces hallucinations (although it's not unknown in some individuals for BZDs to produce them too)

I've never done nor had first-hand experience of either, but from what I can tell there is a good deal of common ground between the "hallucinogenic" effects of the two (muscimol and zolpidem) - dreamy, delerious hallucinations that are more akin to anticholinergic hallucinations (e.g. Datura), loss of significant parts of memory, and at times unpleasant inebreation. Muscimol is less selective and therefore a lot more intense though.

Zolpidem is just a fucking wierd drug. It brings some people out of comas (temporarily), try to explain that...

Serotonin syndrome is only a risk if you combine two drugs that increase the synaptic concentrations of serotonin, like MAOIs, MDMA, tramadol et cetera. (or combining a drug like a SSRI with another that dangerously increases blood SSRI levels or blocks metabolism of the SSRI, of which there are not many - just a few hard core anitbiotics, and phenobarbital I think) It's excellent you're asking rather than assuming, bur I wish people wouldn't expect that serotonin syndrome can occur from every single psychoactive drug.

 

[cook]

Sleep deprivation seems to bring the possible hallucinations of zolpidem much more probable. It is the only connection I've found through experimentation. Other than that it just seems pretty random (at regular doses) if the hallucinations are going to show up or not.

 

[blight12]

Very interesting, the hallucinations where always a standard response for me, low dose, not sleep dep, the faces and shapes in a darkened room where prominent.
For a long time i was prescribed it but suffered with otc hystamine tabs instead since the zolpidem freaked me out at the time, until i realised the rec potential and then it was entertaining when expecting a result.

I also remember finding a lot of reports of similar visuals but i was searching for that effect and I guess the few ones i found where perceived as a common response.

I guess then then best experience was the floating sensation when lying still in bed, now i see it could be a tactile hallucination possibly also of the enhanced level of my own experience and thus why nobody can confirm this great effect.

Ill take my gifts and move on, that stuff went from half a pill to 10 in short order with OD feared hospitalization as a conclusion but also sleep driving along the way. Couldn't do that to family anymore, rather avoid thus underrated (in danger) experience.

 

[cook]

I also gave up the medication because it's just unpredictable at times and you start doing strange things with complete amnesia next day. The hallucinations were really intense few times, usually in the form that some objects become living and suddenly the room is full of living things which you can carry conversations with. Also conversations with "spiritual" beings which could not be seen but their voice was heard. It could have been scary first times, but the anti-anxiety properties of zolpidem are pretty good also so at least I felt completely in ease with the situation.

Zolpidem is just wicked stuff.

 

[Jean-Paul]

i just experienced psychosis from not sleeping for 4 days. my hallucinations were not like anything on zopiclone. yes, i realize zopiclone and zolpidem are different, but zopiclone was always trippier for me. so. lunesta/zopiclone, whatever, i have found to be somewhat trippy but were nowhere near psychosis.

i feel a bit like i am hallucinating on zopiclone, in the same way that someone "hallucinates" without really hallucinating. it makes me feel a bit like i am in another reality, but i would never compare it to the effects of real psychosis.

it doesn't matter if you take this with an SSRI, in terms of serious side effects like serotonin syndrome. a doctor would should know better than to prescribe the two together, but if you go in there talking about shadow faces he might just take you off of the ambien anyway.

i agree that these medications can be unpredictable and i am pretty unhappy i will be using lunesta for anxiety soon. (lack of anything else, atm)

 

[ungelesene_bettlek]

I always figured zolpidem produces "hallucinations" by the same mechanism that muscimol does, from selective hyperactivation of (inhibitory) GABA-a receptors probably responsible for what we consider "sanity" and "conciousness", producing a sleep-like delerium, or a sort of lucid dream. It's the most rational explanation I can come up with for why the Z-drugs are really the only class of "GABA sedatives" that produces hallucinations (although it's not unknown in some individuals for BZDs to produce them too)

that interpretation is of course tempting, because both zolplidem and muscimol seem to be GABAergic hallucinogens. yet I do not think that this leads to anywhere because of two reasons:

1. although both drugs act at the GABA receptor, they bind to different sites: zolpidem modulates the GABA receptor by binding to the benzodiazepine binding site, while muscimol binds at the same site as GABA itself, mimicing its action. obviously this makes a big difference, because

2. I have experience with both the zolpidem induced hallucinogenic state and the psychedelic effects of amanita muscaria mushrooms, and they are not alike at all. the zolpidem intoxication is similar to an alcohol inebriation with heavy memory loss and uncontrolled behaviour that is for me only sometimes accompanied with minor optical effects, that can be nice at times (colored spots flying through the air, photos getting animated), but are not that impressive at all. the fly agaric, on the other hand, is one of the most powerful entheogens I ever tried. its action is highly bizarre and very hard to describe; there was a lot of mess with the flow of time, and a state that somehow resembles both an ego loss experiences with 5HT2A psychedelics and a dissociative hole, but with very unique properties.

if there is anything similar to muscimol, I guess it would be gaboxadol. it is/was a sleeping aid that resembles the action of muscimol and is also structurally similar. too bad it will never leave the clinical testing stage.

 

[blight12]

i just experienced psychosis from not sleeping for 4 days. my hallucinations were not like anything on zopiclone. yes, i realize zopiclone and zolpidem are different, but zopiclone was always trippier for me. so. lunesta/zopiclone, whatever, i have found to be somewhat trippy but were nowhere near psychosis.

i feel a bit like i am hallucinating on zopiclone, in the same way that someone "hallucinates" without really hallucinating. it makes me feel a bit like i am in another reality, but i would never compare it to the effects of real psychosis.

it doesn't matter if you take this with an SSRI, in terms of serious side effects like serotonin syndrome. a doctor would should know better than to prescribe the two together, but if you go in there talking about shadow faces he might just take you off of the ambien anyway.

i agree that these medications can be unpredictable and i am pretty unhappy i will be using lunesta for anxiety soon. (lack of anything else, atm)

I just wanted to clarify and confirm that to me the Zolpidem effects dont resemble sleep dep or amp psychosis but rather the fully conscious hallucinatory effects caused by those two states before psychosis takes effect. For example in amp psychosis trip reports when they are seeing shadow people but still know its not real. When you still know whats going on basically.