Washington: Insomnia, a common sleep problem is also a driver of suicide, but a new study has found a probable and safe answer to this. People with severe insomnia may benefit from a sedative to resolve their sleep problems, as it reduces suicidal thoughts, the study published in The American Journal of Psychiatry stated.
"If your patient says their sleep problem is really bad and they have had thoughts of killing themselves, maybe they should have a targeted treatment for their insomnia," said corresponding author, Dr Vaughn McCall, chair of the Department of Psychiatry and Health Behavior at the Medical College of Georgia at Augusta University.
He is hoping the REST-IT (Reducing Suicidal Ideation Through Insomnia Treatment) study, the first clinical trial looking at whether targeted insomnia treatment reduces suicide risk, will help change that. "While the results do not argue for the routine prescription of hypnotics for mitigating suicidal ideation in all depressed outpatients with insomnia, they suggest that co-prescription of a hypnotic during initiation of an antidepressant may be beneficial in suicidal outpatients, especially in patients with severe insomnia," the investigators wrote.
The study at MCG, Duke University and the University of Wisconsin included 103 participants aged between 18 to 65 with major depressive disorder, insomnia and suicidal thoughts. Thirty per cent had a prior suicide attempt, however, individuals with an active and imminent plan to commit suicide were excluded out of concern for their safety since it was an outpatient study.
All participants took an antidepressant for the eight-week duration of the trial and half also took the sedative-hypnotic zolpidem at bedtime. Participants completed regular self-reports of the severity of their insomnia and completed a daily sleep diary during their treatment including details like the times they woke up during the night and how long they actually slept.
Investigators also measured distorted thoughts about sleep, like a participant thinking they would never again have a good night's sleep. The frequency and intensity of disturbing dreams or nightmares, also a factor in insomnia-associated suicide, were measured. Patients wore a wrist device to keep up with rest/activity cycles.
Depression severity was measured by psychiatry staff at each study visit and participants also completed the Beck Hopelessness Scale, which measures pessimism and negative expectations and is considered a predictor of suicidal behaviour in adults and adolescents. Those taking the sleep aid showed both significant immediate and longer-term improvement in their reported insomnia severity.
While both groups reported significant improvement in their feelings about hopelessness, quality of life, nightmares and dysfunctional beliefs about sleep, as well as related insomnia and suicidality, the group taking the sleep aid had a greater reduction in suicidal thinking, the investigators report.
Sleep aid was most effective in reducing suicidal thoughts in patients with the most severe insomnia. The investigators note the safety of using narcotics in patients with suicidal thoughts and the fact that participants largely followed study protocols very well also were important findings.
Participants only received a week's supply of sleep aid until their suicidal thoughts began to abate, and the sleep aid was stopped after eight weeks. Afterward, their condition remained the same or continued to improve, McCall said. A possible reason all participants benefitted could be the extra attention they received over the course of the study.
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