Evidence map›Paper›PMID 27609243›Full record

ReviewThe American journal of psychiatry2017

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

W Vaughn McCall, Ruth M Benca, Peter B Rosenquist, Mary Anne Riley, Laryssa McCloud, Jill C Newman, Doug Case, Meredith Rumble, Andrew D Krystal

Open access · bronzeAbstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in The American journal of psychiatry, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 51 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
51citing papers in PubMed, 2 pooled it
18.3field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

51 citing papers in PubMed, 2 syntheses or guidelines pooled it, 135 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Trial
  4. Trial
  5. Characteristics of people who report firearm suicidal ideation in the USA.Injury prevention : journal of the International Society for Child and Adolescent Injury Prevention · 2026
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  11. Sleep disturbance and maladaptive sleep-related cognitions in borderline personality disorder in the longitudinal McLean Study of Adult Development.Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine · 2025
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  16. Review
  17. Intravenous ketamine for benzodiazepine deprescription and withdrawal management in treatment-resistant depression: a preliminary report.Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology · 2023
    Article
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

9 authors at 1 institution in 1 country.

W Vaughn McCallFrom 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.
Ruth M BencaFrom 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.
Peter B RosenquistFrom 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.
Mary Anne RileyFrom 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.
Laryssa McCloudFrom 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.
Jill C NewmanFrom 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.
Doug CaseFrom 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.
Meredith RumbleFrom 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.
Andrew D KrystalFrom 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.
Augusta University Health · US

Funding

1/3-Reducing Suicial Ideation Through Insomnia Treatment (REST-IT)R01MH095776 · NIMH · AUGUSTA UNIVERSITY · PI MCCALL, WILLIAM VAUGHN · 2012 to 2016
$1.2M
3/3-Reducing Suicidal Ideation Through Insomnia Treatment (REST-IT)R01MH095778 · NIMH · UNIVERSITY OF WISCONSIN-MADISON · PI BENCA, RUTH M · 2012 to 2016
$991k
2/3-Reducing Suicide Ideation Through Insomnia Treatment (REST-IT)R01MH095780 · NIMH · DUKE UNIVERSITY · PI KRYSTAL, ANDREW D · 2012 to 2016
$904k
NIMH NIH HHS R01 MH095776NIMH NIH HHS R01 MH095778NIMH NIH HHS R01 MH095780
6 · The paper itself

Abstract

objectiveInsomnia 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.

methodThis 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.

resultsEpidemiological 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.

conclusionsThe 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.

Indexed as

Suicide PreventionUnited States Food and Drug AdministrationAdultAgedCause of DeathCohort StudiesDose-Response Relationship, DrugHumansHypnotics and SedativesMiddle AgedProduct Surveillance, PostmarketingProspective StudiesRiskSleep Initiation and Maintenance DisordersSuicidal IdeationSuicideHypnotics and SedativesSleepSuicide

Identifiers

PMID27609243
PMCPMC5205566
OpenAlexW2510989636

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.