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On March 14, 2007, the FDA issued a warning regarding the risks associated with Ambien and similar drugs. It warned that Ambien and similar drugs can cause "complex sleep-related behaviors which may include sleep-driving, making phone calls, and preparing and eating food (while asleep)." When this happens, the FDA advised that the person has "no memory of the event." Similar warnings were issued by the Australian Adverse Drug Reactions Advisory Committee in 2002 and then again in 2007. It cautioned to "be alert to the fact that zolpidem [Ambien] may be associated with distressing neurological or psychiatric reactions …." Similarly, the instructions for Ambien, which were approved by the FDA and are dated August 29, 2005, advise that:

"A variety of abnormal thinking and behavior changes have been reported to occur in association with the use of sedative/hypnotics. Some of these changes may be characterized by decreased inhibition (e.g., aggressiveness and extroversion that seemed out of character), similar to effects produced by alcohol and other CNS depressants. Visual and auditory hallucinations have been reported as well as behavioral changes such as bizarre behavior, agitation, and depersonalization. Amnesia, anxiety and other neuro-psychiatric symptoms may occur unpredictably."

The National Highway Traffic Safety Administration has also described the behavior exhibited by drivers stopped for DUI who, were not intoxicated with alcohol, but instead found to be on Ambien. NHTSA describes the behavior of Ambien drivers to include "erratic driving (weaving, lane travel), slow and slurred speech, slow reflexes, dazed appearance, disorientation, confusion, loss of balance and coordination, loss of short-term memory, blacking out, somnolence, dilated pupils, double vision, poor performance on field sobriety tests, poor attention, and an inability to stand or walk unassisted." This description is consistent with the information contained on the Mayo Clinic web site which states: "Some changes that have occurred in people taking this medicine are like those seen in people who drink alcohol and then act in a manner that is not normal."

When these side effects of Ambien are viewed as a percentage of the total number of people taking Ambien, they can be categorized as rare. But, when viewed by the frequency of cases reported, they are not insignificant. For example, Wisconsin is a state that tests for Ambien whenever a person is charged with DUI. In that state alone, the number of drivers stopped for DUI and testing positive for Ambien has gone from 24 in 2000 to 53 in 2005. Indeed, the number of people who have suffered these strange behaviors are sufficient for them to have acquired a special name. They are called "Ambien Zombies."

The type of behaviors that people have experienced from Ambien vary widely. The most commonly reported are "sleep walking," "sleep eating," and "sleep driving." However, one common thread that appears consistent throughout is amnesia. The people who experience these behaviors are in a twilight zone at the time, somewhere between sleep and wakefulness. They are not conscious of their behavior and, afterwards, do not recall anything about what they have done. For example, Ken Sassower, a staff neurologist at Massachusetts General Hospital in Boston said that a colleague who had taken Ambien, could not recall advising residents on rounds the next morning even though he made those rounds.

In other cases,

1. People have made phone calls or sent E-mails they don't remember, have ordered items from shopping channels they don't recall, have done laundry, cooked, cleaned the house, moved furniture, and found all sorts of debris in their kitchens from late night snacks they don't remember.

2. They've eaten things like non-edible objects, raw eggs, uncooked vegetables, and even cigarettes with no recollection of ever doing these things.

3. Still others have reported that, after falling asleep on Ambien, they took more Ambien without any recollection of doing so and one person reported taking all of her allergy medication, with no recollection of taking it. She only realized she had taken the allergy medication when she found the medicine bottle empty the next morning.

4. A physician in South Dakota reported that he sent a mass e-mail one night, full of foul language, to many friends and family inviting them to go on vacation to Mexico.

5. In another case, a New York lab technician was assaulted twice after taking Ambien when she opened her door for a stranger, something she said she would have never done if she'd been conscious.

6. The behaviors can be quite bizarre. For example, one woman colored her daughter purple while she was sleeping, another woman painted her front door without being conscious of doing it, and another woman defacated during the night in her closets and on the basement floor. None of them had any recollection of these events. And, in London, a girl left her house and climbed to the top of a 40 meter crane.

8. In many cases, after taking Ambien, people have driven in their sleep with no recollection of what happened the next morning. Doctors affiliated with the University of Minnesota Medical Center reported the cases of two Ambien users who told them they slept-drove to the supermarket while under the drug's influence but had no recollection of doing this the next day. In a separate Internet posting, a man reported that he woke up in his driveway with his car bumper in the front seat of his car with him. While he has no recollection of what occurred, he presumed he ran over something in the middle of the night, pulled his (plastic) bumper off, put it in the front seat and drove home. In another case, a woman, after taking Ambien, woke up in a hotel two hours from her home with no recollection of driving anywhere. Ambien has even blemished the pristine driving record of a registered nurse in Denver. After taking Ambien and going to bed, she got into her car wearing only a thin nightshirt in 20-degree weather. After having a fender bender, she urinated in the middle of the intersection and became violent to police officers.

9. With respect to the hallucinations that can be caused by Ambien, one person writes: "I would literally see images, like faces, in the walls or in the designs of tile floors." And another person relates experiencing "crazy nightmares that upon waking I swear these were real and that I had actually talked to the people in the dream."

10. One woman reports that she was awaken by her daughter about 4 hours after taking Ambien. Her daughter asked her to sign some papers, which she did, after which she made breakfast for her and her daughter. Thereafter, she drove her daughter to her friend's house and then drove both of them to school. On the way back home, she stopped a strange man in a vehicle and approached him for his phone number but, after refusing her request, she gave him her phone number. Thereafter, she drove home and slammed her car into the garage wall. She then telephoned her father and told him about hitting the wall with her car. Later, she could remember nothing about any of these events.

11. Another person reported, that after going to sleep on Ambien, he was awakened by a friend. Subsequently, he did not recall anything about his friend awakening him or what he did after he was awoken. However, his friend told him that, when he awoke, he became violent and exhibited multi-personalities each with a different voice.

12. There are also cases that involve side effects experienced the day after ingesting Ambien. Indeed, the manufacturer's instructions, dated August 29, 2005, recognizes this when it warns that patients may experience effects "that may occur the day following ingestion." Examples of instances reported include one person who reported that he woke up 16 hours after taking Ambien and his wife and children described him as a "walking zombie." He "cooked up a storm," "emptied a ¼ bottle of vodka," and trashed the bedroom. His wife and children tried to wake him up but they were unsuccessful. Typical of Ambien side effects, he had no recollection of any of these events. In another case, a woman reports that, 14 hours after taking Ambien, she wrecked two cars in one day and has "little recollection of the incidents." Another person described his next day experiences this way: "I feel so incredibly agitated, drugged and disoriented the next day, that I think I'd rather just feel sleep deprived. It affects my memory and my fine motor coordination and I tremble. I even tried taking a nap during the next day but this doesn't relieve the drugged, disoriented feeling." In another case, an attorney who had been taking Ambien for three years without incident, reported that he has begun to experience some loss of memory and mental acuity during the day and, at a social gathering one night, found himself misstating things. In another case, a man reports that "I just don't remember my morning events for about 3 or 4 hours after I wake up." One morning, after going to work, he went to Starbucks but had no recollection of it until someone mentioned it to him that night.

AMBIEN'S MECHANISM OF ACTION

(I am not a doctor but this is what I have learned about the way Ambien works)

Ambien interacts with the GABAa receptor. GABA is the major inhibitory neurotransmitter of the brain, occurring in 30-40% of all synapses (second only to glutamate as a major brain neurotransmitter). The method by which Ambien works is to increase the affinity of the GABAa receptor to GABA. When GABA binds with a GABAa receptor, (more specifically, the BZ1 subunit of the GABAa receptor) it opens an ion channel that allows Cl- to enter the cell. This results in an electrical change that inhibits or suppresses the post-synaptic neuron from firing. Since GABA is competing with excitatory neurotransmitters, the degree to which it inhibits or suppresses the firing of the postsynaptic neuron is dependent on the number of receptors to which GABA actually binds and the concomitant amount of Cl- that enters the cell through the ion channel. By increasing the affinity of the GABAa receptor to GABA, Ambien increases the number of GABAa receptors to which GABA actually binds. The result is that more ion channels open to allow Cl- into the cell. The more Cl- that enters the cell, the greater is the inhibitory or suppressive effect upon the postsynaptic neuron's ability to fire.

By inhibiting or suppressing the firing of postsynaptic neurons in different parts of the brain in this manner, Ambien suppresses or interferes with the normal operation of the brain's mechanisms. The exact effect depends upon what areas of the brain the firing of the postsynaptic neurons are being inhibited or suppressed and the degree of the inhibition or suppression. One of the regions of the brain containing a high concentration of GABA is the hypothalamus. The hypothalamus affects feeding behavior, metabolism, motor activity, and plays an important role in the control of sleep. Another portion of the brain in which one of the highest concentrations of GABA is found is the hippocampus. This area of the brain plays an essential role in memory formation. It's responsible for the transfer of information into memory. Its importance is illustrated by the fact that damage to the hippocampus can result in substantial difficulties in forming new memories (anterograde amnesia) and can affect access to memories prior to the damage (retrograde amnesia). GABA is also found in high concentrations in the basal ganglia. The basal ganglia affect things like the ability to control speech and movement.

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Q: Crazy things that people do while taking ambien?
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