Insomnia and suicide as reported adverse effects of second-generation antipsychotics and mood stabilizers

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Abstract

STUDY OBJECTIVES: Insomnia and suicide ideation/behavior/death (SIB) are common in psychiatric disorders. There is evidence that clozapine and lithium have anti-suicidal properties and beneficial effects on sleep. We investigated the reported odds of spontaneously reported psychiatric adverse drug reactions (ADRs) of insomnia and SIB in adults for second-generation antipsychotics (SGAs) and mood stabilizers compared to clozapine and lithium, respectively.

METHODS: We searched the U.S. FDA Adverse Event Reporting System from inception through February 2021 for which a SGA or mood stabilizer was the suspected agent of a psychiatric ADR.

RESULTS: We investigated 10 SGAs and 5 mood stabilizers. Compared to clozapine, other SGAs were associated with a significantly increased reported odds of insomnia (rOR=2.41-9.70) and SIB (rOR=1.18-2.72). Compared to lithium, there was a significantly increased reported odds of SIB (rOR=1.17-1.70) for other mood stabilizers, and insomnia (rOR=1.66) for lamotrigine. The insomnia and SIB rORs for SGAs and mood stabilizers were positively correlated.

CONCLUSIONS: Our results are consistent with evidence for anti-suicidal properties of clozapine and lithium. Findings also raise the possibility of beneficial effects on sleep as one potential pathway underlying the anti-suicidal properties for these agents. Future studies are needed to identify underlying biological mechanisms that contribute to these associations.

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