McCall WV, Benca RM, Rosenquist PB, et al. - Researchers examined whether targeted treatment with controlled-release zolpidem (zolpidem-CR) vs placebo for insomnia would provide a superior reduction in suicidal ideation in suicidal adults with insomnia. In Reducing Suicidal Ideation Through Insomnia Treatment, an 8-week three-site double-blind placebo-controlled parallel-group randomized controlled trial, comparison of zolpidem-CR hypnotic therapy vs placebo, in conjunction with an open-label selective serotonin reuptake inhibitor, was done. Among 103 participants, 51 received zolpidem-CR or 52 received placebo. They observed a robust anti-insomnia effect of zolpidem-CR, especially in patients with the most severe insomnia symptoms. It showed no significant treatment effect on the Scale for Suicide Ideation, however, there was a significant positive correlation of the reduction in scores with improvement in insomnia after accounting for the effect of other depression symptoms. The Columbia–Suicide Severity Rating Scale indicated significant treatment effect of zolpidem-CR. In patients with more severe insomnia, greater advantage for zolpidem-CR in reducing suicidal ideation on the C-SSRS was observed. Based on the results, the routine prescription of hypnotic medication for mitigating suicidal ideation in all depressed outpatients with insomnia is not supported. However, they suggest a co-prescription of a hypnotic during initiation of an antidepressant as beneficial in suicidal outpatients, especially in patients with severe insomnia.