Reducing Suicidal Ideation Through Insomnia Treatment (REST-IT): A Randomized Clinical Trial.

Abstract

OBJECTIVE:

The authors sought to determine whether targeted treatment of insomnia with controlled-release zolpidem (zolpidem-CR) in suicidal adults with insomnia would provide a reduction in suicidal ideation superior to placebo.

METHODS:

Reducing Suicidal Ideation Through Insomnia Treatment was an 8-week three-site 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. Participants were medication-free 18- to 65-year-olds with major depressive disorder, insomnia, and suicidal ideation. Suicidal ideation was the main outcome, measured first by the Scale for Suicide Ideation and second by the Columbia-Suicide Severity Rating Scale (C-SSRS).

RESULTS:

A total of 103 participants were randomly assigned to receive zolpidem-CR (N=51) or placebo (N=52) (64 women and 39 men; mean age=40.5 years). Zolpidem-CR had a robust anti-insomnia effect, especially in patients with the most severe insomnia symptoms. 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), but the reduction in scores was significantly positively related to improvement in insomnia after accounting for the effect of other depression symptoms. The C-SSRS indicated that zolpidem-CR had a significant treatment effect (least squares mean estimate=-0.26, SE=0.12, 95% CI=-0.50, -0.02). 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.

CONCLUSIONS:

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.

• Authors: William V McCall, Ruth M Benca, Peter B Rosenquist, Nagy A Youssef, Laryssa McCloud, Jill C Newman, Doug Case, Meredith E Rumble, Steven T Szabo, Marjorie Phillips, Andrew D Krystal
• Journal: The American journal of psychiatry (Am J Psychiatry) Vol. 176 Issue 11 Pg. 957-965 (11 01 2019) ISSN: 1535-7228 [Electronic] United States
• PMID: 31537089 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Chemical References

• Delayed-Action Preparations
• Serotonin Uptake Inhibitors
• Sleep Aids, Pharmaceutical
• Zolpidem

Topics

• Adolescent
• Adult
• Aged
• Delayed-Action Preparations (therapeutic use)
• Double-Blind Method
• Drug Therapy, Combination (methods)
• Female
• Humans
• Male
• Middle Aged
• Selective Serotonin Reuptake Inhibitors (therapeutic use)
• Sleep Aids, Pharmaceutical (therapeutic use)
• Sleep Initiation and Maintenance Disorders (drug therapy)
• Suicidal Ideation
• Young Adult
• Zolpidem (therapeutic use)