Augusta, GA—With all of the concerns related to use of sedatives for patients who complain of insomnia, a new study identifies a meaningful advantage: potentially reducing suicidal ideation.
The study, published in The American Journal of Psychiatry, examined whether targeted treatment of insomnia with controlled-release zolpidem (zolpidem-CR) in depressed adults would relieve some of their suicidal thoughts, compared with placebo.
Medical College of Georgia–led researchers conducted Reducing Suicidal Ideation Through Insomnia Treatment, a double-blind, placebo-controlled, parallel-group, randomized, controlled trial of zolpidem-CR hypnotic therapy compared with placebo, in conjunction with an open-label selective serotonin reuptake inhibitor, for 8 weeks at three sites.
Included as participants were medication-free adults with major depressive disorder, insomnia, and suicidal ideation. The patients were mostly female and had a mean age of 40.5 years. Suicidal ideation was defined as the main outcome, and was measured first by the Scale for Suicide Ideation and second by the Columbia–Suicide Severity Rating Scale (C-SSRS).
“If you have a patient who complains that their sleep has taken a turn for the worse, then there is reason to open the door to a question about suicide,” explained lead author Vaughn McCall, MD, chair of the Department of Psychiatry and Health Behavior at the Medical College of Georgia at Augusta University. “If your patient says their sleep problem is really bad and they have had thoughts of killing themselves, maybe they should have a targeted treatment for their insomnia.”
The 103 participants were randomly assigned to receive either zolpidem-CR or placebo, and results indicate that zolpidem-CR had a robust anti-insomnia effect, especially in patients with the most severe insomnia symptoms. Participants completed regular self-reports of the severity of their insomnia, as well as a daily sleep diary describing how many times they woke up during the night and how long they actually slept.
While no significant treatment effect was observed on the Scale for Suicide Ideation (least squares mean estimate, -0.56; SE = 0.83; 95% CI, -2.19, 1.08), researchers point out that the reduction in scores was significantly positively related to improvement in insomnia after accounting for the effect of other depression symptoms. The C-SSRS, meanwhile, suggested that zolpidem-CR had a significant treatment effect (least squares mean estimate: -0.26; SE = 0.12; 95% CI, -0.50, -0.02).
The study team determined that the advantage for zolpidem-CR in reducing suicidal ideation on the C-SSRS was greater in patients with more severe insomnia. No deaths or suicide attempts occurred during the trial.
“Although the results do not support the routine prescription of hypnotic medication for mitigating suicidal ideation in all depressed outpatients with insomnia, they suggest that coprescription of a hypnotic during initiation of an antidepressant may be beneficial in suicidal outpatients, especially in patients with severe insomnia,” the authors conclude.
The study notes that hypnotics, like the drug used for the study, can be misused to commit suicide or develop dependence. To address these concerns, participants only received a week’s supply of the sleep aid until their suicidal thoughts began to abate, and the sleep aid was stopped after 8 weeks.
McCall added that, in most patients, their condition remained the same or continued to improve over time.
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The study, published in The American Journal of Psychiatry, examined whether targeted treatment of insomnia with controlled-release zolpidem (zolpidem-CR) in depressed adults would relieve some of their suicidal thoughts, compared with placebo.
Medical College of Georgia–led researchers conducted Reducing Suicidal Ideation Through Insomnia Treatment, a double-blind, placebo-controlled, parallel-group, randomized, controlled trial of zolpidem-CR hypnotic therapy compared with placebo, in conjunction with an open-label selective serotonin reuptake inhibitor, for 8 weeks at three sites.
Included as participants were medication-free adults with major depressive disorder, insomnia, and suicidal ideation. The patients were mostly female and had a mean age of 40.5 years. Suicidal ideation was defined as the main outcome, and was measured first by the Scale for Suicide Ideation and second by the Columbia–Suicide Severity Rating Scale (C-SSRS).
“If you have a patient who complains that their sleep has taken a turn for the worse, then there is reason to open the door to a question about suicide,” explained lead author Vaughn McCall, MD, chair of the Department of Psychiatry and Health Behavior at the Medical College of Georgia at Augusta University. “If your patient says their sleep problem is really bad and they have had thoughts of killing themselves, maybe they should have a targeted treatment for their insomnia.”
The 103 participants were randomly assigned to receive either zolpidem-CR or placebo, and results indicate that zolpidem-CR had a robust anti-insomnia effect, especially in patients with the most severe insomnia symptoms. Participants completed regular self-reports of the severity of their insomnia, as well as a daily sleep diary describing how many times they woke up during the night and how long they actually slept.
While no significant treatment effect was observed on the Scale for Suicide Ideation (least squares mean estimate, -0.56; SE = 0.83; 95% CI, -2.19, 1.08), researchers point out that the reduction in scores was significantly positively related to improvement in insomnia after accounting for the effect of other depression symptoms. The C-SSRS, meanwhile, suggested that zolpidem-CR had a significant treatment effect (least squares mean estimate: -0.26; SE = 0.12; 95% CI, -0.50, -0.02).
The study team determined that the advantage for zolpidem-CR in reducing suicidal ideation on the C-SSRS was greater in patients with more severe insomnia. No deaths or suicide attempts occurred during the trial.
“Although the results do not support the routine prescription of hypnotic medication for mitigating suicidal ideation in all depressed outpatients with insomnia, they suggest that coprescription of a hypnotic during initiation of an antidepressant may be beneficial in suicidal outpatients, especially in patients with severe insomnia,” the authors conclude.
The study notes that hypnotics, like the drug used for the study, can be misused to commit suicide or develop dependence. To address these concerns, participants only received a week’s supply of the sleep aid until their suicidal thoughts began to abate, and the sleep aid was stopped after 8 weeks.
McCall added that, in most patients, their condition remained the same or continued to improve over time.
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