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.

中文翻译：

---

通过失眠治疗（REST-IT）减少自杀意念：一项随机临床试验

客观的：

作者试图确定自杀性失眠成人用控释唑吡坦（zolpidem-CR）进行的失眠靶向治疗是否能提供优于安慰剂的自杀意念降低效果。

方法：

通过失眠治疗降低自杀意念是一项与安慰剂相比，结合开放标签选择性5-羟色胺再摄取抑制剂的唑吡坦-CR催眠治疗的8周三位双盲安慰剂对照平行组随机对照试验。参加者为18至65岁的重度抑郁症，失眠和自杀意念的免费药物。自杀意念是主要结果，首先通过自杀意念量表进行衡量，其次通过哥伦比亚－自杀严重程度量表（C-SSRS）进行衡量。

结果：

共有103名参与者被随机分配接受唑吡坦-CR（N = 51）或安慰剂（N = 52）（64名女性和39名男性；平均年龄= 40.5岁）。Zolpidem-CR具有很强的抗失眠作用，尤其是在最严重的失眠症状患者中。在自杀意念量表上未观察到明显的治疗效果（最小二乘法均值= -0.56，SE = 0.83，95％CI = -2.19，1.08），但评分降低与核算后失眠的改善呈显着正相关。对于其他抑郁症状的影响。C-SSRS表明唑吡坦-CR具有显着的治疗效果（最小二乘均值= -0.26，SE = 0.12，95％CI = -0.50，-0.02）。失眠更为严重的患者使用唑吡坦-CR可以减少C-SSRS上的自杀念头。没有死亡或自杀企图。

结论：

尽管结果并不支持所有失眠抑郁患者的常规催眠药处方以减轻其自杀意念，但他们认为，在抗抑郁药启动期间共同处方催眠药可能对自杀性门诊患者有益，尤其是对于严重失眠的患者。