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What is the background?

Randomised trials suggest that suicidal behaviour is twice as likely when children and young adults receive antidepressants compared to placebo. However, adults older than 24 years do not seem to be at increased risk of self-harm. No previous studies assess whether antidepressant dose influences deliberate self-harm.

What was the design?

A study of 162,625 people in the US aged 10 to 64 years who started selective serotonin reuptake inhibitors (SSRIs).

What were the results?

People 24 years of age or younger beginning high-dose SSRIs were approximately twice as likely to self-harm (hazard ratio 2.2) than matched controls starting at the average (calculated as mode) dose. Overall, about one additional self-harm event occurred for every 136 patients aged 10-24 years treated with high-dose SSRIs. No doseresponse relationship emerged among adults aged 25-64 years.

What were the conclusions?

Children and young adults starting high-dose SSRIs seem to be more likely to deliberately self-harm than those taking average doses. Recent meta-analyses concluded that the efficacy of antidepressants is €modest€ in younger people. Other studies show that the antidepressant dose €is generally unrelated to therapeutic efficacy€. Therefore, the authors comment, the €findings offer clinicians an additional incentive to avoid initiating pharmacotherapy at hightherapeutic doses and to closely monitor patients starting antidepressants, especially youth, for several months€.

Reference

Miller M, Swanson SA, Azrael D, Pate V, Stürmer T. Antidepressant dose, age, and the risk of deliberate self-harm. JAMA Intern Med (doi:10.1001/jamainternmed.2014.1053)