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Study Explores Whether Sleeping Pills Can Reduce Suicidal Thoughts in Depressed Patients With Insomnia

Suicide risk factors and prevention often overlook sleeplessness, researcher says (Jan. 22)

“The more we look at it, the more it looks like insomnia by itself is a predictor of suicide, so the next question becomes: Why not treat insomnia strategically as a focus of care and see if that reduces suicidal thinking,” said principal investigator Dr. W. Vaughn McCall.

The new study mdash; which is being conducted at Georgia Regents University, Duke University, and the University of Wisconsin mdash; will enroll a total of 138 adults over 4 years. To help ensure their safety, all participants will receive the antidepressant fluoxetine for the 8-week trial, while half will also receive the sedative-hypnotic zolpidem.

Some physicians, however, are understandably concerned about giving sleeping pills to people with suicidal thoughts. “We are faced very commonly with a patient who is not sleeping, is depressed, [and] is suicidal, and the treating physician is understandably concerned about giving that patient sleeping pills,” McCall said.

In fact, some sleep experts routinely condemn sleeping pills, saying the pills are potentially deadly, independent of suicide. Other people with chronic insomnia never seek professional help, trying home or natural remedies while their negative thoughts about sleep escalate. If they do seek medical care as problems mount, they may find themselves with a doctor hesitant or even adamant about not using hypnotics, McCall said. If the researchers can show a direct link between the treatment of insomnia and reduced suicidal thinking, it could help mainstream targeted drug therapy as well as non-drug approaches, such as cognitive behavior therapy — a structured talk therapy that targets faulty thinking, such as, “I will never sleep again,” said McCall, who also uses this approach.

The researchers have evidence that the intensity of insomnia correlates with the intensity of suicidal thoughts as well as a pilot study that linked proactive hypnotic treatment to reduced suicidal thoughts. A total of 31 studies have linked insomnia to suicidal thoughts, behavior, or death. Still, suicide risk factors and prevention strategies often overlook insomnia, McCall said.

Acknowledging the vulnerable population that is being studied, the researchers have built numerous safeguards into the research protocol, such as giving participants only 1 week’s supply of sleeping pills for the first 2 weeks, and then giving them a 2-week supply if their suicidal thoughts stabilize. Additionally, they will be asked to take the drug shortly before going to bed and to allow 8 hours for sleep.

About half of all cases of insomnia are related to a mental disorder, such as depression. About 90% of patients hospitalized for depression and 60% of those treated as outpatients also have insomnia, McCall said. Participants will be referred for outpatient management at the end of the study.

Source: Georgia Health Sciences University; January 22, 2013.

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