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Hypnotics may increase risk for suicidal ideation, suicide

A literature review indicated that FDA-approved hypnotic medications were associated with increased risk for suicidal ideation.

“A growing body of evidence has linked insomnia to suicidal ideation, suicidal behavior, and suicide death,” W. Vaughn McCall, MD, MS, of Medical College of Georgia, Augusta University, Augusta, and colleagues wrote. “Based on available reviews and epidemiological surveys, the link between sedative-hypnotic agents and suicidality appears to be uncertain. However, no review has considered published case reports of suicide death as related to hypnotic medication or considered adverse event reports on suicide and hypnotics in the FDA’s 2006 postmarketing safety review of zolpidem, zaleplon, and eszopiclone (the ‘Z-drugs’).”

W. Vaughn McCall

To assess the claim that hypnotics increase risk for suicide, researchers reviewed PubMed and Web of Science for articles on suicide and modern, FDA-approved hypnotics in adults. They also searched the FDA website for postmarketing safety reviews and requested detailed case reports for hypnotic-related suicide deaths from the FDA’s Adverse Event Reporting System.

Epidemiological studies indicated an association between hypnotics and increased risk for suicide; however, none of the studies effectively controlled for depression or other psychiatric disorders that may be related to insomnia.

Analysis indicated that suicide deaths were reported from single-agent hypnotic overdoses.

Researchers expressed concern regarding benzodiazepine receptor agonist hypnotics, which can cause parasomnias and may lead to suicidal ideation or behavior in individuals not known to be suicidal.

Despite this, there is ongoing research assessing whether treatment for insomnia reduces suicidality in adults with depression.

“The principal new contribution of this review is the clarification regarding the timing of suicide risk related to ingestion of hypnotics. Under specific conditions, hypnotics may induce or exacerbate suicidality by altering consciousness or disinhibition at the time of peak drug effect, and at the same time may reduce or prevent suicidal ideation in persons with insomnia and mental illness after appropriate drug metabolism,” the researchers concluded. – by Amanda Oldt

Disclosure: McCall reports receiving honoraria from Anthem, CME Outfitters, Global CME, and Wolters Kluwer. Please see the full study for a list of all authors’ relevant financial disclosures.