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HIgh Doses of Antidepressants May Boost Youth Suicide Risk

Update Date: Apr 28, 2014 09:32 PM EDT

High doses of antidepressants may increase the risk of suicidal behavior in children and young adults, according to a new study.

New research reveals that kids and young adults who start antidepressant therapy at high doses rather than average doses seem to be at greater risk of suicidal behavior during the first 90 days of treatment.

Previous research by the U.S. Food and Drug Administration (FDA) suggested that children administered antidepressants had twice the rate of suicidal ideation and behavior than children who were given a placebo.

Researchers in the latest study wanted to see whether suicidal behavior was influenced by antidepressant dose.

The latest research used data from 162,625 people aged 10 to 64 years with depression who started antidepressant treatment with a selective serotonin reuptake inhibitor at medium or higher than medium dose from 1998 through 2010.

The findings revealed that the rate of suicidal behavior among children and adults younger than 24 who started antidepressant therapy at high doses was double the rate of patients in a matched group who were prescribed modal doses.

However, the risk of suicidal behavior among adults aged 25 to 64 showed no difference between modal and high doses.

Researchers were unable to determine why higher doses of selective serotonin reuptake inhibitor treatment might increase the risk of suicide.

"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," Matthew Miller, M.D., Sc.D., of the Harvard School of Public Health, Boston, and colleagues wrote in the study.

"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," researchers David A. Brent, M.D., of the University of Pittsburgh, and Robert Gibbons, Ph.D., of the University of Chicago wrote in a related commentary.

"Moreover, while definitive studies on the impact of dose escalation in the face of non-response 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 suicidal behavior after the initiation of antidepressants in youth treated at the modal dosage," they concluded.

The findings are published in the journal JAMA Internal Medicine.

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