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

..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.

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.