Suicide attempt during ramelteon addition to flunitrazepam: A case report

Area of Science:

• Pharmacology
• Neuroscience
• Clinical Psychiatry

Background:

• Benzodiazepines, like flunitrazepam, are associated with disinhibition, potentially causing aggression, impulsivity, self-harm, and suicide attempts.
• Ramelteon is generally considered less likely to cause disinhibition.

Observation:

• A case study involving a 43-year-old female with primary insomnia is presented.
• Flunitrazepam monotherapy did not elicit disinhibition.
• The co-administration of ramelteon with flunitrazepam resulted in disinhibition, characterized by aggressiveness and culminating in a suicide attempt.

Findings:

• The patient's disinhibition and aggressive behavior resolved rapidly upon discontinuation of ramelteon.
• This suggests a potential synergistic effect between ramelteon and flunitrazepam in inducing disinhibition in certain individuals.

Implications:

• The combination of ramelteon and flunitrazepam may pose a risk for suicide attempts in susceptible patients.
• Clinicians should exercise caution when prescribing this combination, particularly in patients with a history of psychiatric distress.
• Further research is warranted to elucidate the mechanisms underlying this interaction and identify at-risk populations.