High doses of antidepressants appear to increase risk of self-harm in children young adult

April 28, 2014, The JAMA Network Journals
Fluoxetine (Prozac). Image: Wikimedia Commons

Children and young adults who start antidepressant therapy at high doses, rather than the "modal" [average or typical] prescribed doses, appear to be at greater risk for suicidal behavior during the first 90 days of treatment.

A previous meta-analysis by the U.S. Food and Drug Administration (FDA) of antidepressant trials suggested that children who received antidepressants had twice the rate of suicidal ideation and behavior than children who were given a placebo. The authors of the current study sought to examine suicidal behavior and antidepressant dose, and whether risk depended on a patient's age.

The study used data from 162,625 people (between the ages of 10 to 64 years) with depression who started antidepressant treatment with a selective serotonin reuptake inhibitor at modal (the most prescribed doses on average) or at higher than modal doses from 1998 through 2010.

The rate of suicidal behavior (deliberate self-harm or DSH) among children and adults (24 years or younger) who started antidepressant therapy at high doses was about twice as high compared with a matched group of patients who received generally prescribed doses. The authors suggest this corresponds to about one additional event of DSH for every 150 patients treated with high-dose therapy. For adults 25 to 64 years old, the difference in risk for suicidal behavior was null. The study does not address why higher doses might lead to higher suicide risk.

Follow Medical Xpress updates on Facebook: facebook.com/medicalxpress

"Considered in light of recent meta-analyses concluding that the efficacy of antidepressant therapy for youth seems to be modest, and separate evidence that dose is generally unrelated to the therapeutic efficacy of antidepressants, our findings offer clinicians an additional incentive to avoid initiating pharmacotherapy at high-therapeutic doses and to monitor all patients starting antidepressants, especially youth, for several months and regardless of history of DSH." Matthew Miller, M.D., Sc.D., of the Harvard School of Public Health, Boston, and colleagues wrote in their JAMA Internal Medicine article.

In a related commentary, David A. Brent, M.D., of the University of Pittsburgh, and Robert Gibbons, Ph.D., of the University of Chicago, write: "In summary Miller et al are to be commended on a thoughtful and careful analysis of the effects of initiating antidepressants at higher than modal doses."

"Their findings suggest that higher than modal initial dosing leads to an increased risk for DSH and adds further support to current clinical recommendations to begin treatment with lower antidepressant doses. While initiation at higher than modal doses of antidepressants may be deleterious, this study does not address the effect of dose escalation," they continue.

"Moreover, while definitive 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. Finally it should be noted that in this study, there was no pre-exposure to post-exposure increase in after the initiation of antidepressants in youth treated at the modal dosage," they conclude.

Explore further: Suicide risk doesn't differ in children taking two types of commonly prescribed antidepressants

More information: JAMA Intern Med. Published online April 28, 2014. DOI: 10.1001/jamainternmed.2014.1053
JAMA Intern Med. Published online April 28, 2014. DOI: 10.1001/jamainternmed.2013.14016

Related Stories

Suicide risk doesn't differ in children taking two types of commonly prescribed antidepressants

January 6, 2014
A Vanderbilt University Medical Center study released today shows there is no evidence that the risk of suicide differs with two commonly prescribed antidepressants prescribed to children and adolescents.

Antidepressant-suicide link in youths absent in new analysis

February 6, 2012
In 2004, concerns about antidepressant drugs increasing suicidal thoughts and behaviors in young patients prompted the FDA to issue a rare "black box warning." Now, a new analysis of clinical trial data finds that treatment ...

Young adults not at risk of suicidal behavior from antidepressants

July 6, 2007
Antidepressants lower the risk of suicide attempt in adults with depression, according to a study published in the July issue of the American Journal of Psychiatry. The researchers also found that the lower risk held true ...

Combination of treatments could lead to lower and safer doses of medication in children with ADHD

April 8, 2014
Balancing a low dose of behavior therapy with a low dose of medication may be the key to helping children with Attention Deficit Hyperactivity Disorder (ADHD), according to a new study by researchers at FIU's Center for Children ...

FDA warning against high dose antidepressant prescription may be unwarranted, study finds

May 3, 2013
The U.S. Food and Drug Administration's warning that high doses of the antidepressant citalopram can cause potentially serious abnormal heart rhythms might be doing more harm than good.

First UK study of ketamine for people with severe depression

April 2, 2014
The first UK study of the use of ketamine intravenous infusions in people with treatment-resistant depression has been carried out in an NHS clinic by researchers at Oxford Health NHS Foundation Trust and the University of ...

Recommended for you

New research has revealed we are actually better at remembering names than faces

November 14, 2018
With the Christmas party season fast approaching, there will be plenty of opportunity to re-live the familiar, and excruciatingly-awkward, social situation of not being able to remember an acquaintance's name.

Brain changes found in self-injuring teen girls

November 13, 2018
The brains of teenage girls who engage in serious forms of self-harm, including cutting, show features similar to those seen in adults with borderline personality disorder, a severe and hard-to-treat mental illness, a new ...

The illusion of multitasking boosts performance

November 13, 2018
Our ability to do things well suffers when we try to complete several tasks at once, but a series of experiments suggests that merely believing that we're multitasking may boost our performance by making us more engaged in ...

Major traumatic injury increases risk of mental health diagnoses, suicide

November 12, 2018
People who experience major injuries requiring hospital admission, such as car crashes and falls, are at substantially increased risk of being admitted to hospital for mental health disorders, found a study in CMAJ (Canadian ...

Nearly one in ten Americans struggles to control sexual urges

November 9, 2018
(HealthDay)—The #MeToo movement has given many Americans a glimpse into an unfamiliar world that may have left many wondering, "What were they thinking?"

Brain activity pattern may be early sign of schizophrenia

November 8, 2018
Schizophrenia, a brain disorder that produces hallucinations, delusions, and cognitive impairments, usually strikes during adolescence or young adulthood. While some signs can suggest that a person is at high risk for developing ...


Adjust slider to filter visible comments by rank

Display comments: newest first

5 / 5 (2) Apr 28, 2014
Let alone the 99% of mass shooters are all on some sort of anti-depressant. But it's the guns fault.
blow vee ate
5 / 5 (2) Apr 28, 2014
This is amazing news. The warning labels warn of suicidal and violent behavior in the test groups made up of adults, then you pump a bunch of kids (who have even less psychological foundational experience) up on it with manly man sized dosages and you get......
Extremely violent and suicidal behavior!

Im astounded. Floored. I need to pick my jaw back up.

Really, there needs to be some liability suits or some kind of AMA sanctioning on all these "professionals" who think doping our children up on massive doses of psycho drugs is a great idea and the parents need to be slapped everlasting silly.
3 / 5 (2) Apr 28, 2014
Once again we end up with scientists telling us they know the deal and government using that as justification for pushing an agenda. It's gotten to where I trust a scientist as far as I can throw a politician.
5 / 5 (2) Apr 28, 2014
Surprise, surprise! You need anti-depressant - smoke some pot..... oh...wait.... it might cause to feel better.... can't do that because big drug companies can't make big bucks and give large amounts to politicians! Wake up America.
not rated yet Apr 29, 2014
Once again we end up with scientists telling us they know the deal and government using that as justification for pushing an agenda. It's gotten to where I trust a scientist as far as I can throw a politician.

Science "bad" !

Just because the big pharma "Scientits" are garbage, that doesn't mean all scientists are like that. Quire the opposite is true.

This study shows an example of why the actual scientists are not important however. The only thing that matters is the actual Science. There are no authorities in science.

Your stance of not trusting scientists is highly illogical. Look to the science itself.

Politicians on the other hand are generally terrible people.

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.