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Antidepressants and Violence: Problems at the Interface of Medicine and Law

  • Published: September 12, 2006
  • DOI: 10.1371/journal.pmed.0030372

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"Confusion" With GABAergic Hypnotics and Violence

Posted by plosmedicine on 31 Mar 2009 at 00:24 GMT

Author: Mathew Pankratz
Position: Researcher
Institution: Private
E-mail: pankratzm@uwstout.edu
Submitted Date: April 11, 2008
Published Date: April 15, 2008
This comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.

With hypnotics like Zolpidem and Zopiclone- the two "z" hypnotics selective for a1-subunit containing GABA-A receptors, it seems laughable to write off any violence caused under the influence as caused by the drug. We do not accept this as an excuse for violence caused under the influence of ethanol- which, though no a1-selective, has similar effects at related receptor subtypes.

How can we, as a society, choose to ignore or excuse idiotic things done under the influence of one drug but not another with very similar effects? Use and abuse of pharmaceuticals is a growing trend that's seen as less dangerous and more socially acceptable (and though I have no personal feeling against drug use of any kind) we must apply a standard set of rules and punishments regardless of the drugs origin and legality.

I believe that the idea of true sleep-walking under these drugs influence is extremely rare. The main determinant seems to be that the user fails to remember what they did while under it's influence. A1-selective drugs produce profound amnesia, but they produce smaller decreases in inhibition than many realize.

When I was in college I was prescribed s-Zopiclone (Lunesta in the United States, racemic Immovane in the UK) during a period of exceptionally bad insomnia. Initially, I took a smaller dose than prescribed and did not fall asleep immediately. It produced a drunken state in which I decided to cook everything I could- very badly. This is the sort of behavior typically described as "sleepwalking" but it was definitely not. I believe that, since my dose was lowered, I was able to retain a decent, but hazy, memory of what transpired.

Later I increased by dose to the full prescribed 3mg and proceeded to do lots that were stupid, although safe enough under the watchful eye of my wife. Afterwards, however, I had no memory.

Does this mean that my stupidity can be written off as sleepwalking? I don't think so. A lack of memory and decreased inhibitions caused by a pharmaceutical or alcohol have very little that isn't nearly identical.

It's wrong to excuse bad behaviors committed under the influence of either.

No competing interests declared.