Science Forums 2

[CraigD]

Originally Posted by Michaelangelica

Zolpidem / Stilnox

…
How long does it take for the message to get though?

It’s a complicated message, so not only may it take a while to get through, it’s hard to guess what it will be when it does. It may not be that Stilnox/Zoloft (Zolpidem) should be banned.

From The SMH article, there are a few complicating factors with in the case of Mairead Costigan’s untimely death:

• She didn’t die from drug toxicity or overdose, but from a fall, either accidental or intentional (suicide)
• She wasn’t taking Zoloft when she fell to her death, but another sleep aid, Imovane/ Lunesta (Zopiclone), a drug with a similar effect but significantly different pharmochemistry than Zoloft.
• She appears to have had medical/mental health issues other than the insomnia being treated by the Zoloft and Lunesta.
  Though the article doesn’t provide information such as her height, from looking at it’s photo, I wonder if she suffered from some body self-image disphoria resulting in anorexia, as she appears significantly underweight in this photo, which I’m guessing shows her at 51 kg, vs. her recent low weight of “the low-40s”.
  I don’t think we can speculate meaningfully about the factors contributing to Costigan’s death without a more complete medical/psychiatric history, which it would be inappropriate for people other than her caregivers to have, and inappropriate for them to discuss on the internet.

Hypnotic sleep aid drugs like Zoloft and Lunesta present a complicated situation for the clinician. They’re much lower toxicity than the early drugs they replace (barbituates), so are safer to prescribe, especially for people you suspect of being depressed and possibly suicidal – giving a potentially suicidal person a supply of barbituate adequate for a painless, fatal over dose is, obviously, a very bad idea. However, this increased safety can cause clinicians to neglect therapy and follow up.

Costigan is an atypical case, having (I’m guessing) better than typical financial, medical, and social resources. Psychiatric mistreatment is, in my experience, more common among the less resourced, where physician case loads are higher and quality of care typically lower. Especially strange to me is that a PhD student in a university philosophy department would come to such an end, as I assume she had at least the possibility of access to good conventional psychotherapists through. My experience with such academic settings is that psych faculty put extraordinary effort into helping people in their neighboring departments, affording some of the best psychiatric care I’ve ever seen. Unfortunately, as may be the case with Costigan, sometimes the best efforts of many capable people aren’t enough.

Another thing that concerns me about hypnotic sleep aids is that, despite manufacturer literature and other research indicating that they have a low potential for abuse, I know for a fact that many people are abusing them. Though many people seem able to use them for months on end without any tendency toward overmedication or recreational use, some people seem to find these drugs enticingly nice and fun. Though a “soft” drug compared to the older barbiturates and many illicit drugs, they’re very available on the gray market, and I’ve seen folk, especially young ones, use them recreationally in situation chillingly similar to the article’s description of Costigan’s last moments.

The best result that could come out of this and other attention about limitations and dangers of sleep aid drugs, IMHO, would be a shift toward non-drug treatments of insomnia, particularly sleep studies. Unfortunately, these treatments are more expensive than drugs-based treatments, so such a shift may prove difficult.