A commentary on Hypnotic Medications and Suicide: Risk, Mechanisms, Mitigation, and the FDA by McCall WV, Benca RM, Rosenquist PB, Riley MA, McCloud L, Newman JC, et al. Am J Psychiatry (2016). doi:10.1176/appi.ajp.2016.16030336 McCall and colleagues (1) recently published a review entitled “Hypnotic Medications and Suicide: Risk, Mechanisms, Mitigation, and the FDA” in the September 2016 issue of the American Journal of Psychiatry. They noted that although epidemiological studies have demonstrated that hypnotic sedatives are associated with an increased risk for suicide, none of these studies adequately have controlled for depression and/or other psychiatric disorders. However, McCall et al. conclude that their review findings indicate that hypnotic sedative medications are associated with suicidal ideation and that future studies should 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 (1). We believe there is a difference between the following two clinical situations, e.g., when suicide is induced by the recommended use of certain hypnotic medication for insomnia versus when the hypnotic sedative medication is used simply as a vehicle to commit suicide. Clearly, excessive use of any substance can potentially be harmful and even fatal. Pure water, for example, if taken in excessive quantity, may cause serious complications, including death (2). The first case of self-induced water intoxication was reported in 1938 by Barahal (3). Epidemiologically, several lines of accumulating evidence have indicated that polydipsia was found in 6–17% of chronic psychiatric patients. A total of 25–50% of psychiatric patients with polydipsia have been reported to have symptoms of water intoxication (4). Under such circumstances, therefore, the relationship between deaths and water intoxication is of causality rather than association. Yet, there are no such warnings as, “Water use may cause deaths” or “drinking water is associated with deaths” on any water bottles. Overwhelmed Web information is already a problem for patients to look for evidence about the drug they are taking, which may adversely impact their expectations about their improvement...
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