High Initial Antidepressant Dosages in Youth May Raise Risk for Deliberate Self-harm, Study Finds

High initial dosages of antidepressants appear to increase risk of deliberate self-harm in children and young adults, according to data from a study published in JAMA Internal Medicine. Researchers from the Harvard School of Public Health conducted a study to examine the relationship between suicidal behavior and antidepressant dosage, and whether such a relationship, if it exists, is dependent on a patient's age. The study assessed data from 162,625 people—aged 10 to 64—with depression who initiated antidepressant therapy with a selective serotonin reuptake inhibitor at “modal” (most prescribed dose on average) or higher than modal dosages.

The analysis showed that participants aged 24 and younger who initiated antidepressant therapy at high doses were twice as likely to exhibit suicidal behaviors than were their age-matched counterparts who received modal doses—corresponding to one additional event of deliberate self-harm for every 150 patients treated with high-dose antidepressant therapy. The authors found no dose-dependent risk for suicidal behavior among adults aged 25 to 64.

In a commentary, David Brent, M.D., a professor of psychiatry, pediatrics, and epidemiology at the University of Pittsburgh, who was not involved in the study noted that "while initiation at higher than modal doses of antidepressants may be deleterious, this study does not address the effect of dose escalation… Studies on the impact of dose escalation in the face of nonresponse remain to be done, there are promising studies that suggest in certain subgroups, dose escalation can be of benefit.” However, Brent concluded, these findings "add further support to current clinical recommendations to begin treatment with lower antidepressant doses."

To read about prescribing practices of antidepressants for child and adolescent patients, see the Psychiatric News article, "Prescribing for Mentally Ill Children Generally in Line With Best Practices." To read about challenges clinicians face in preventing and managing suicidal behavior, see the American Psychiatric Publishing Textbook of Suicide Assessment and Management, Second Edition.

(Editor's note: In a Psychiatric News Alert yesterday, we used an incorrect term to describe pediatric IBD in children. It should have been "inflammatory" bowel disease, not "irritable" bowel disease. We apologize for the error.)

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