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

William V McCall, Ruth M Benca, Peter B Rosenquist, Nagy A Youssef, Laryssa McCloud, Jill C Newman, Doug Case, Meredith E Rumble, Steven T Szabo, Marjorie Phillips, Andrew D Krystal

Research output: Contribution to journalArticle

8 Scopus citations

Abstract

OBJECTIVE: The authors sought to determine whether targeted treatment of insomnia with controlled-release zolpidem (zolpidem-CR) in suicidal adults with insomnia would provide a reduction in suicidal ideation superior to placebo.

METHODS: Reducing Suicidal Ideation Through Insomnia Treatment was an 8-week three-site double-blind placebo-controlled parallel-group randomized controlled trial of zolpidem-CR hypnotic therapy compared with placebo, in conjunction with an open-label selective serotonin reuptake inhibitor. Participants were medication-free 18- to 65-year-olds with major depressive disorder, insomnia, and suicidal ideation. Suicidal ideation was the main outcome, measured first by the Scale for Suicide Ideation and second by the Columbia-Suicide Severity Rating Scale (C-SSRS).

RESULTS: A total of 103 participants were randomly assigned to receive zolpidem-CR (N=51) or placebo (N=52) (64 women and 39 men; mean age=40.5 years). 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.

Original languageEnglish (US)
Pages (from-to)957-965
Number of pages9
JournalThe American journal of psychiatry
Volume176
Issue number11
DOIs
StatePublished - Nov 1 2019
Externally publishedYes

Fingerprint Dive into the research topics of 'Reducing Suicidal Ideation Through Insomnia Treatment (REST-IT): A Randomized Clinical Trial'. Together they form a unique fingerprint.

  • Cite this

    McCall, W. V., Benca, R. M., Rosenquist, P. B., Youssef, N. A., McCloud, L., Newman, J. C., Case, D., Rumble, M. E., Szabo, S. T., Phillips, M., & Krystal, A. D. (2019). Reducing Suicidal Ideation Through Insomnia Treatment (REST-IT): A Randomized Clinical Trial. The American journal of psychiatry, 176(11), 957-965. https://doi.org/10.1176/appi.ajp.2019.19030267