Suicide rates have increased steadily over the last 15 years by 12.5-15.0 per 100,000 individuals, and reducing suicide risk will be a task of enormous importance in the coming years. Both insomnia and the medications used to treat insomnia are associated with increased suicide risk, but the nature of these associations are unclear. Does insomnia lead to greater suicidal ideation and risk? Do the sedating and often disinhibiting medications used to treat insomnia lead to suicidal behaviors?
McCall et al. recently published a randomized trial in the American Journal of Psychiatry which may help answer these questions. The investigators randomized patients with major depression and insomnia who expressed suicidal ideation to either continuous release zolpidem or placebo. All patients were without suicidal plans or intent at baseline, and were followed with the Scale for Suicide Ideation (SSI) and Columbia-Suicide Severity Rating Scale (CSSRS) over 8 weeks. SSI improved in both arms, with no significant difference between groups (least squares mean for treatment effect -0.56, 95% CI -2.19, 1.08). However, in a secondary analysis, the suicidal ideation score of CSSRS did show an advantage for the zolpidem group (-0.26, 95% CI -0.50, -0.02).
Overall, the authors' findings suggest that treating insomnia may improve suicidal ideation. More work will be needed to further assess the impact of insomnia treatment in other populations at risk for suicide, and the impact of non-pharmacologic insomnia treatments (e.g. Cognitive Behavioral Therapy).
