Insomnia Drug Reduces Suicidal Ideation

W. Vaughn McCall, MD

A common drug that treats short-term sleeping problems could reduce suicidal ideation in patients with severe insomnia symptoms.

A team of investigators led by W. Vaughn McCall, MD, MS Case Distinguished University Chair of the Department of Psychiatry and Health Behavior at Augusta University, found in an 8-week, 3-site, double-blind, placebo-controlled parallel-group, randomized controlled trial that zolpidem (zolpidem-CR) hypnotic therapy in conjunction with an open-label selective serotonin reuptake inhibitor could be beneficial for suicidal outpatients with severe insomnia.

The study included 103 medication-free patients from 18-65-years old with major depressive disorder, insomnia, and suicidal ideation.

A total of 51 patients in the study received zolpidem-CR, while 52 received a placebo.

The main outcome of the study was suicidal ideation, measured by the Scale for Suicide Ideation, as well as the Columbia-Suicide Severity Rating Scale (C-SSRS).

The investigators found that the drug had a robust anti-insomnia effect, particularly for the patients with the most severe symptoms.

They did not observe a substantial treatment effect on the Scale for Suicide Ideation (95% CI, -2.19-1.08), but the reduction in scores was significantly positive related to improvement in insomnia after accounting for the effect of other depression symptoms.

The C-SSRS score was a different story. This score indicated that the medication had a significant impact (95% CI,−0.50-−0.02).

They also found that the impact of zolpidem-CR was greater in reducing suicidal ideation on the C-SSRS in patients with more severe insomnia.

There were no deaths or suicide attempts during the study.

“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 wrote.

A 2016 study found that insomnia and nightmares influence depression symptoms, particularly through the pathway of explicit emotion regulation difficulties.

The study included an internet-based survey of 880 current and retired US firefighters, aged 18-82 years, who answered questions regarding behavioral health. Self-report measures included the Center for Epidemiologic Studies Depression Scale, Insomnia Severity Index, PTSD Checklist, and Difficulties in Emotion Regulation Scale.

Approximately 40% of the participants reported clinically significant depression symptoms, with more than 50% reporting insomnia symptoms and 20% reporting nightmare problems. All 3 of these symptoms demonstrate a strong association with emotion regulation difficulties.

“Our study findings suggest that firefighters with sleep difficulties are likely to experience greater struggles accessing strategies to regulate their emotions, especially when feeling upset. This, in turn, may lead to or worsen feelings of depression and low mood,” said lead author Melanie Hom, MS, a doctoral candidate in the Laboratory for the Study and Prevention of Suicide-Related Conditions and Behaviors within the Department of Psychology at Florida State University.

The study, “Reducing Suicidal Ideation Through Insomnia Treatment (REST-IT): A Randomized Clinical Trial,” was published online in The American Journal of Psychiatry.