zolpidem is a short - acting nonbenzodiazepine hypnotic of the imidazopyridine class used for short - term treatment of insomnia .
zolpidem selectively activates only one of the benzodiazepine binding sites of the gabaa receptor ( alpha-1 ) which may account for its selective sedative effects and relative lack of muscle relaxant and anticonvulsant effects compared to benzodiazepines .
previously , some rare cases of zolpidem - induced hallucinations have been reported from developed countries .
a 20-year - old female patient visited our psychiatric clinic with sadness of mood and irritable behavior for 4 months .
now she would remain worried and preoccupied with thoughts of her marital life most of the time in a day with gradual loss of interest in pleasurable as well as routine activities .
she had to push herself to go to office and would not take much interest in grooming herself now .
her biological functions were disturbed and her risk assessment for suicide revealed a high score .
she was diagnosed as a case of major depressive disorder and was put on paroxetine 12.5 mg twice a day and zolpidem 10 mg at bed time for sleep .
next day , she reported with complaints of experiencing dream - like pleasurable state in which there was lilliputian like visual and elementary auditory hallucinations after half an hour of ingestion of zolpidem .
the mood disturbances observed in the patient slowly over the next 3-month treatment were replaced by euthymia most of the time .
the patient started doing her routine activities and no any hallucinations were reported by the patient in her follow - up .
in the index case report , the patient developed hallucinations after intake of first dose of zolpidem .
patient experienced lilliputian visual and elementary auditory hallucinations within half -an hour of intake of zolpidem .
its onset of action is usually within 15 minutes and its half - life is 2.6 hours .
, the australian therapeutic goods administration attached a black box warning to zolpidem , stating , that  zolpidem may be associated with potentially dangerous complex sleep - related behaviours that may include sleep walking , sleep driving , and other psychotic behaviours .
 keto and koga reported visual hallucinations in an 82-year - old woman with diagnosis of major depressive disorder after 1 and half month of administration of zolpidem .
in contrast , our index patient reported the visual hallucination on the first night . there are reports of occupational hazards with zolpidem - induced hallucinations in a 54-year old driver and the continued use of zolpidem with fluoxetine resulted in nystagmus and gait disturbances .
it was recommended that zolpidem be used for short periods of time using the lowest effective dose .
zolpidem 10 mg is effective in treating insomnia when used intermittently no fewer than three and no more than five pills per week for a period of 12 weeks .
tsai et al . postulated that visual hallucinations associated with zolpidem may be related to sudden withdrawal and restarting of zolpidem .
further the author hypothesized the mechanism of this phenomena was associated with alteration in the gaba - a receptor .
the author also suggested that zolpidem should never be used  as needed  basis and the dose should be lowest effective dose .
zolpidem has not proven effective in maintaining sleep and is more used for sleep initiation problems .
our case highlights that clinicians must be aware of the various pharmacological properties of zolpidem and this molecule can induce hallucinations as was observed in the indexed case .
further , such cases suggest more research in this clinical area for the better wellbeing of the patients .
 we are reporting a case of zolpidem - induced hallucinations in a 20-year - old patient . 
 the duration of this phenomenon was brief , 15 - 20 minutes . 
 our case suggests that clinicians must be aware of this phenomenon while prescribing zolpidem . 
INTRODUCTION
CASE REPORT
DISCUSSION