Preliminary communication Nightmares, suicide attempts, and melancholic features in patients with unipolar major depression Mehmet Yucel Agargun, Lutfullah Besiroglu, Ali Savas Cilli, Mustafa Gulec ⁎ , Adem Aydin, Rifat Inci, Yavuz Selvi Yuzuncu Yil University School of Medicine, Department of Psychiatry, Kazim Karabekir Street, Van, 65200, Turkey Received 30 June 2006; received in revised form 26 July 2006; accepted 1 August 2006 Available online 28 August 2006 Abstract Objectives: Recently, there has been a growing interest in the relationship between sleep disturbances and suicidality in major depression. Sleep disturbances are one of the ‘modifiable risks’ for suicide in major depression. The present study examines whether there is a relationship among nightmares, suicide attempts, and melancholic features in unipolar major depressed patients. Methods: One hundred (49 males and 51 females) depressed patients with melancholic features and 49 (23 males and 26 females) patients without melancholic features were included in the study. All patients were classified as those who attempted suicide at least once during current depressive episode and as those who never attempted. Results: Melancholic attempters had higher rates of nightmares, middle, and terminal insomnia than melancholic non-attempters. There was no significant difference between non-melancholic patients with and without suicidal attempts in terms of the frequency of all types of insomnia and nightmares. Limitations: This study does not have polysomnographic records for sleep variables. Conclusions: Feeling worse in the morning than later in the day may be related to the intervening dream content and affect and predict suicidal tendency. Melancholia may be associated with increased risk of suicide attempts due to repetitive and frightening dreams. © 2006 Elsevier B.V. All rights reserved. Keywords: Suicide; Nightmares; Insomnia; Melancholic features; Depression 1. Introduction Recently, there has been an increasing interest in the relationship between sleep and suicidality in major depression. Major suggestion is that sleep disturbances have prognostic significance in predicting suicide among patients with mood disorders (Agargun and Besiroglu, 2005). Fawcett et al. (1990) considered insomnia to be one of the ‘modifiable risks’ for suicide. In a recent study, Agargun et al. (1997a) showed that not only insomnia but also hypersomnia associated with suicidal behavior in depressed patients. Agargun et al. (1997b) also de- monstrated a significant association between poor sleep quality and suicidal behavior in depression. Melancholic features are related to short REM latency and increased REM density in depressed patients (Giles et al., 1986; Rush and Weissenburger, 1994). As an es- sential feature of melancholia, negative affective state in the morning might be related to the intervening dream content and affect in major depression (Besiroglu et al., 2005). Melancholia is associated with more serious past suicide attempts and with the probability of suicide attempt during follow-up (Grunebaum et al., 2004). On Journal of Affective Disorders 98 (2007) 267 – 270 www.elsevier.com/locate/jad ⁎ Corresponding author. Tel.: +90 43 221 504 73. E-mail address: mustafagulec78@yahoo.com (M. Gulec). 0165-0327/$ - see front matter © 2006 Elsevier B.V. All rights reserved. doi:10.1016/j.jad.2006.08.005