McCall W Vaughn, Benca Ruth M, Rosenquist Peter B, Riley Mary Anne, McCloud Laryssa, Newman Jill C, Case Doug, Rumble Meredith, Krystal Andrew D
From the Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta; the Department of Psychiatry and Human Behavior, University of California, Irvine; the Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, N.C.; the Department of Psychiatry, University of Wisconsin, Madison; and the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, N.C.
Am J Psychiatry. 2017 Jan 1;174(1):18-25. doi: 10.1176/appi.ajp.2016.16030336. Epub 2016 Sep 9.
Insomnia is associated with increased risk for suicide. The Food and Drug Administration (FDA) has mandated that warnings regarding suicide be included in the prescribing information for hypnotic medications. The authors conducted a review of the evidence for and against the claim that hypnotics increase the risk of suicide.
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 web site was searched for postmarketing safety reviews, and the FDA was contacted with requests to provide detailed case reports for hypnotic-related suicide deaths reported through its Adverse Event Reporting System.
Epidemiological studies show that hypnotics are associated with an 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 suicidal. On the other hand, ongoing research is testing whether treatment of insomnia may reduce suicidality in adults with depression.
The review findings indicate that hypnotic medications are associated with suicidal ideation. Future studies should be designed to assess whether increases in suicidality result from CNS impairments from a given hypnotic medication or whether such medication decreases suicidality because of improvements in insomnia.
失眠与自杀风险增加相关。美国食品药品监督管理局（FDA）已强制要求在催眠药物的处方信息中加入有关自杀的警示。作者对支持和反对催眠药物会增加自杀风险这一说法的证据进行了综述。
本综述聚焦于现代的、获FDA批准的催眠药物，从苯二氮䓬类药物问世开始，研究结果仅限于成年人。检索了PubMed和科学网，将“自杀”和“自杀性的”这两个术语与每种现代的、获FDA批准的催眠药物进行交叉检索。在FDA网站上搜索上市后安全性综述，并联系FDA，请求其提供通过不良事件报告系统上报的与催眠药物相关的自杀死亡详细病例报告。
流行病学研究表明，催眠药物与自杀风险增加相关。然而，这些研究均未充分控制可能与失眠相关的抑郁症或其他精神障碍。已有单剂催眠药物过量导致自杀死亡的报告。另一个问题是，苯二氮䓬受体激动剂类催眠药物可引发异态睡眠，在极少数情况下，这可能导致原本无自杀倾向者出现自杀念头或自杀行为。另一方面，正在进行的研究正在测试失眠治疗是否可降低抑郁症成年人的自杀倾向。
综述结果表明，催眠药物与自杀念头相关。未来的研究应设计用于评估自杀倾向的增加是由特定催眠药物的中枢神经系统损害所致，还是由于失眠改善使得此类药物降低了自杀倾向。
