Dr. Matthew Miller of the Harvard School of Public Health in Boston and colleagues, analyzed data from 162,625 people ages 10 to 64 with depression who started antidepressant treatment with an SSRI at the most prescribed doses or at higher than average doses from 1998 to 2010.
The study, published in JAMA Internal Medicine, found the rate of suicidal behavior -- or deliberate self-harm -- among children and adults age 24 or younger, who began antidepressant therapy at high doses was about twice as high during the first 90 days of treatment compared to a control group of patients who received generally prescribed doses.
The authors suggest this increased risk corresponds to about one additional event of deliberate self-harm for every 150 patients treated with high-dose therapy. However, there was no difference in risk for suicidal behavior in adults ages 24 to 65.
“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 deliberate self-harm.”