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“Insomnia symptoms are a driver of suicidal ideation,” wrote William V. McCall, M.D., of the Medical College of Georgia at Augusta University and colleagues. The findings suggest that “hypnotic medications are effective for insomnia in suicidal outpatients with major depressive disorder and that the resolution of suicidal ideation positively covaries with resolution of insomnia symptoms.”
The researchers designed an eight-week study with 103 patients aged 18 to 65 who had major depressive disorder, suicidal thoughts, and insomnia and had started to take one of three SSRIs (fluoxetine, sertraline, or citalopram). These patients were randomized into two groups: one group took controlled-release zolpidem (zolpidem-CR), and the other took placebo. During follow-up visits at weeks 1, 2, 4, 6, and 8, the researchers evaluated the participants for suicidal thoughts (using the Scale for Suicide Ideation and the Columbia–Suicide Severity Rating Scale, or C-SSRS), insomnia (using the Insomnia Severity Index), depression (using the Hamilton Depression Rating Scale), adverse events, and more.
Beginning the first week, patients in the zolpidem-CR group reported greater improvements in insomnia compared with those taking placebo; these improvements were predominantly in participants who had reported severe insomnia at the start of the trial.
“We did not find that adding zolpidem-CR to an SSRI provided an advantage in decreasing suicidal ideation scores on the Scale for Suicide Ideation, but we did find an advantage for zolpidem-CR in the suicide ideation score on the C-SSRS. As with the effect in insomnia scores, the effect of zolpidem-CR on C-SSRS suicide ideation scores was numerically greater in those patients with severe baseline insomnia,” McCall and colleagues wrote.
Over the course of the trial, the participants in the zolpidem-CR and placebo groups also showed significant improvements in measures of depression, quality of life, dysfunctional beliefs and attitudes about sleep, and more. However, there were no differences between the treatment groups on any of these outcomes.
“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 concluded.
For related information, see the Psychiatric News article “Overlapping Symptoms Complicate Diagnosis, Treatment of Psychiatric and Sleep Disorders.”
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