A hypnotic added to an antidepressant helped to modestly decrease observer-rated suicidal ideation, especially in patients with severe insomnia.

In a first-ever randomised controlled trial, researchers examined controlled-release (CR) zolpidem or placebo added to open treatment with a selective serotonin reuptake inhibitor (SSRI) in 103 medication-free patients with major depression, insomnia (delayed onset or prolonged awake periods after sleep onset, plus low sleep efficiency), and suicidal ideation (but no plan or intent). At 8 weeks of the study, ratings of insomnia and suicidal ideation fell in all groups. Zolpidem-CR improved insomnia more than placebo.

Decades ago, Swiss and German psychiatrists popularised dauerschlaf (prolonged sleep therapy), now long out of favour, for severe psychoses. Experts comment that this study reminds us that attention to sleep quality might benefit both depression and suicidal ideation. These findings do not support routine hypnotics for depression but do suggest that patients with insomnia and suicidal ideation might well benefit from focused attention to sleep improvement.