Monthly Archives: March 2010

Ambien

Hamlet by William Shakespeare

“To sleep, perchance to dream…,” Hamlet wondered  in his famous To Be or Not to Be soliloquy.

If he lived in modern times, Hamlet would probably pop an ambien and call it a night if he desired to sleep. This popular sleeping aid is gaining quite a bit of attention in the mainstream celebrity world- it’s use amongst celebs is almost as ubiquitous as their active Twitter accounts.

Jay-Z along with Alicia Keys raps about it in Empire State of Mind in reference to partying in NYC- “the city never sleeps, better slip you an ambien”; John Mayer tweets about his personal use and sings about it in Heartbreak Warfare; Jimmy Fallon jokes about it on his late-night talk show; and Tiger Woods probably takes it on nights before playing in the majors. Why not? He takes it for crazy ambien sex with one of his many former mistresses. You probably remember that infamous night he crashed his SUV which led to the unraveling of his secret lifestyle- yep, he was driving under the influence of ambien.

Ambien is a sedative or hypnotic prescription medication that knocks you out like a left hook from Manny Pacquiao.  It was first approved by the FDA in 1992 for the short-term treatment of insomnia. But it didn’t gain widespread use until the generics (zolpidem) came out in 2007. Although not approved for treatment of chronic insomnia, it is not uncommon for doctors to prescribe it for long-term use.

Common side-effects of ambien are drowsiness, impaired motor function, and a drugged feeling.  But more interestingly, side-effects may also include hallucinations, amnesia, euphoria, increased appetite and libido, and extroversion in social settings. And these effects may perhaps be the reason behind  the trend in ambien misuse for recreational purposes.  There are also many documented reports of ambien-related bizarre behavior, ie.  people cleaning out their fridge from sleep-eating politicians involuntarily joining the DUI club from sleep-driving, and wives engaging in unusual sexual behavior of which they have no recollection.

Before the days, or nights, of ambien, the common sleeping pills were the benzos (xanax, valium, ativan) and the barbiturates. These medications are far more dangerous than ambien. They are addictive and lethal in overdoses.  Guess which prescription meds were found in Marilyn Monroe, Jimi Hendrix, and Heath Ledger when they prematurely died?

Ambien is potentially lethal in an overdose since it’s a sedative, especially if combined with alcohol. The cause of death is cessation of breathing. Fortunately, there aren’t too many documented cases, if any,  of death primarily by ambien overdose. In my own clinical experience, I haven’t seen any yet.

Hamlet was contemplating suicide in his soliloquy- “for in that sleep of death what dreams may come.”  If he were to take a large dose of ambien, he would be at some risk of a fatal overdose. But he’s more likely to hallucinate and engage in an ongoing conversation with the skull until he falls soundly asleep, and not remember a thing the following morning.

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Darkness


Shutter Island (2010)

Shutter Island, the recently released psychological thriller, fortified by the Scorsese-DiCaprio combo, brings to light the dark history of psychiatry (I will not reveal any spoilers, so no need to fret if you plan on seeing this movie). I definitely recommend this film- it’s gripping, eerie and suspenseful, and not gratuitously scary. I watched the movie with several of my psychiatry co-residents, and most of us were quite impressed.

The story is set in the 1950’s, which happens to be a revolutionary period in psychiatry. Two key medications were discovered around that time to treat severe mental illnesses once thought to be unmanageable. Lithium, a mood stabilizer, was used in 1948 to successfully treat bipolar disorder and Thorazine was found to be the first effective antipsychotic medication to treat schizophrenia in 1952.

The use of medications to treat mental illnesses, or psychopharmacology, was instrumental to paving the way to deinstitutionalizing psychiatric patients- that is, transitioning patients from living permanently in locked institutions to living functionally in the community. Prior to the practice of psychopharmacology, many of the therapeutic methods of psychiatric treatment in the early part of the twentieth century were not only experimental, but harsh, cruel, and extreme.  The one that undoubtedly ranks at the top is the lobotomy.

Lobotomy is a surgical procedure performed to damage the frontal lobe of the brain, which sits directly behind the forehead. This region of the brain is essentially what differentiates us from other animals. It functions to help us make complex decisions, express our unique personalities, and engage in acceptable social behaviors. Without a functional frontal lobe, we would be no better than a donkey (and I’m not referring to the one in Shrek– that donkey has personality, albeit inappropriate). The most infamous type of lobotomy was the transorbital lobotomy, developed by Dr. Walter Freeman in 1946.  He made it a 10 minute “office procedure” using mainly an ice pick and a hammer, approaching the brain through the roof of the eye socket (you’ve got to click on the link to see for yourself).

The premise behind the lobotomy was that psychiatric illnesses were a result of malfunctioned nerves connecting the frontal lobe to other brain regions. In turn, severing the faulty nerves will allow for new healthy ones to regenerate, thus relieving the psychiatric symptoms.  This hypothesis proved costly to be invalid and wrong, at the expense of many patients.  Sadly, despite being a controversial procedure even since its introduction in 1936, it was commonly used and widely accepted by the medical profession in the 40’s and 50’s. By 1951, almost 20,000 lobotomies were performed altogether in the US.

Fortunately, with the advent of the antipsychotic medications in the 1950’s, lobotomy died off almost as abruptly as it rose up (although psychosurgery is still currently indicated and effective for severe OCD). The beginning era of psychopharm helped move psychiatry into its current and brighter age.

As if in the darkness of the time period in psychiatry’s history during which Shutter Island takes place, DiCaprio uses matches to light his way on the creepy island.  The film’s storyline is just as disturbing and dark as its historical and scenic backdrop, if not more.

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Filed under Film, History