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.

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.

https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.2019.19030267