Association Between Zolpidem and Suicide: A Nationwide Population-Based Case-Control Study

Sun, Yu; Lin, Chih‐Hsueh; Lu, Chien Jung; Hsu, Chung Y.; Kao, Chia Hung

doi:10.1016/j.mayocp.2015.10.022

Cited by 51 publications

(43 citation statements)

References 24 publications

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“…Each suicide case was matched on age, gender, occupation, and urban vs rural setting with 10 controls without history of suicide attempts. (17) The adjusted odds ratio for exposure to zolpidem was 2.08 (1.83–2.36) and remained significant regardless of whether depression, insomnia, anxiety, bipolar disorder or other comorbidities were present. However, the study was limited by imprecision in establishing the diagnoses of depression, insomnia and other mental disorders, and the lack of measurement of severity of symptoms between the cases and controls.…”

Section: Resultsmentioning

confidence: 90%

Hypnotic Medications and Suicide: Risk, Mechanisms, Mitigation, and the FDA

McCall¹,

Benca²,

Rosenquist³

et al. 2017

AJP

108

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Objective Insomnia is associated with increased risk for suicide. The Food and Drug Administration (FDA) has warnings regarding suicide in the prescribing information of hypnotics. We conducted a review of the evidence for and against hypnotics increasing the risk of suicide. Method This review focused on modern, FDA-approved hypnotics, beginning with the introduction of benzodiazepines, limiting its findings to adults. PubMed and Web of Science were searched, crossing the terms ‘suicide’ and ‘suicidal’ with each of the modern FDA-approved hypnotics. The FDA website was searched for post-marketing safety reviews, and the FDA was contacted to provide detailed case reports for hypnotic-related suicide deaths reported through its Adverse Event Report system. Results The epidemiological studies show that hypnotics are associated with increased risk for suicide. However, none of these studies adequately controlled for depression or other psychiatric disorders that may be linked with insomnia. Suicide deaths have been reported from single-agent hypnotic overdoses. A separate concern is that benzodiazepine receptor agonist hypnotics can cause parasomnias, which in rare cases may lead to suicidal ideation or suicidal behavior in persons who were not known to be previously suicidal. On the other hand, ongoing research is testing whether treatment of insomnia might reduce suicidality in depressed adults. Conclusions This review indicates hypnotic medications are associated with suicidal ideation. Future studies should be designed to assess both types of possible effects: 1) an increase in suicidality due to central nervous system impairments from a given hypnotic medication; and 2) a decrease in suicidality due to improving insomnia.

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Section: Resultsmentioning

confidence: 90%

Hypnotic Medications and Suicide: Risk, Mechanisms, Mitigation, and the FDA

McCall¹,

Benca²,

Rosenquist³

et al. 2017

AJP

108

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“…In a large study from Taiwan, the adjusted suicide hazard ratio for “needing sleeping pills” was 11.1, whereas the hazard ratio for those reporting sleeping only 0–4 hours adjusted for sleeping pill use was only 3.5, and none of the hazard ratios for insomnia symptoms exceeded 2.0 79 . Another national Taiwan study found increased suicides and attempts associated with zolpidem 74 . The findings indicate that the association of suicides with hypnotic use cannot be entirely attributed to confounders with reverse causality, since the association of hypnotic usage with depression is known to be largely caused by the hypnotics 23 .…”

Section: Hypnotics Increase Incidence Of Clinical Depressionmentioning

confidence: 98%

“…Suicide has been recently described as the 8 th or 10 th leading cause of death in the United States 7, 73 . Hypnotic use is associated with high rates of suicide 25, 55, 74 . Indeed, comprehensive toxicological studies have found intoxicating abusable substances (mainly sedative-hypnotics) in a majority of suicides, often combined with alcohol in 30–40% 9 .…”

Section: Hypnotics Increase Incidence Of Clinical Depressionmentioning

confidence: 99%

Hypnotic drug risks of mortality, infection, depression, and cancer: but lack of benefit

Kripke

2016

F1000Res

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This is a review of hypnotic drug risks and benefits, reassessing and updating advice presented to the Commissioner of the Food and Drug Administration (United States FDA). Almost every month, new information appears about the risks of hypnotics (sleeping pills). This review includes new information on the growing USA overdose epidemic, eight new epidemiologic studies of hypnotics’ mortality not available for previous compilations, and new emphasis on risks of short-term hypnotic prescription. The most important risks of hypnotics include excess mortality, especially overdose deaths, quiet deaths at night, infections, cancer, depression and suicide, automobile crashes, falls, and other accidents, and hypnotic-withdrawal insomnia. The short-term use of one-two prescriptions is associated with greater risk per dose than long-term use. Hypnotics are usually prescribed without approved indication, most often with specific contraindications, but even when indicated, there is little or no benefit. The recommended doses objectively increase sleep little if at all, daytime performance is often made worse, not better, and the lack of general health benefits is commonly misrepresented in advertising. Treatments such as the cognitive behavioral treatment of insomnia and bright light treatment of circadian rhythm disorders might offer safer and more effective alternative approaches to insomnia.

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“…Zolpidem is gaining popularity as a short-acting hypnotic with few side effects, nevertheless, some side effects such as sedation, somnolence, dizziness, diarrhea, headache, fatigue, memory loss, visual hallucination, and rare cases of sleep walking, dependency, sleep-related eating disorder, and suicide attempting are reported along with this medication (2,4,(16)(17)(18)(19). Perceptional symptoms such as visual hallucination is also reported after taking Zolpidem (4).…”

Section: Discussionmentioning

confidence: 99%

Zolpidem Induces Depersonalization and Derealization Symptoms: A Case Report

Abedini

Esmaeili

2017

Mod Care J

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The purpose of this study is to present the case of Depersonalization and Derealization induced by Zolpidem. symptoms of depersonalization may occur in individuals who suffer from additional mental disorders, various medical conditions, and/or have taken certain medications. The subject was a 24-year-old male patient who has consumed 20 mg of Zolpidem for the treatment of primary insomnia. He complained that he suffered from a strange feeling in his limbs and hands along with a feeling of change in the environment immediately after the medication. His symptoms ceased after treatment was stopped and recurred when he restarted the drug. Medications and medical as well as psychiatric conditions, which are associated with causing symptoms of depersonalization, are reported here and the postulated pathogenesis by which some of these drugs induced depersonalization symptoms is also discussed. Medication-associated with depersonalization symptoms are typically resolved once the inducing drug has been withdrawn. We performed research questions regarding the side effect of Zolpidem and etiology of derealization as well as depersonalization in all of the databases and citation indexes. There were no results relevant to the research question. Therefore, we should assess medications such as Zolpidem as well as psychiatric conditions that are associated with causing symptoms of depersonalization.

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Association Between Zolpidem and Suicide: A Nationwide Population-Based Case-Control Study

Cited by 51 publications

References 24 publications

Hypnotic Medications and Suicide: Risk, Mechanisms, Mitigation, and the FDA

Hypnotic Medications and Suicide: Risk, Mechanisms, Mitigation, and the FDA

Hypnotic drug risks of mortality, infection, depression, and cancer: but lack of benefit

Zolpidem Induces Depersonalization and Derealization Symptoms: A Case Report

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