According to the authors of this paper, meta-analyses of randomized trial data suggest that suicidal behavior is twice as likely when children and young adults are randomized to antidepressants compared with when they are randomized to placebo. In this report, Miller and colleagues assessed the risk of deliberate self-harm by antidepressant dose, and by age group.

This was a propensity score–matched cohort study using population-based health care utilization data from 162 625 US residents with depression, ages 10 to 64 years, who initiated antidepressant therapy with selective serotonin reuptake inhibitors at modal or at higher than modal doses for the years 1998  through 2010.

The rate of deliberate self-harm among children and adults 24 years of age or younger who initiated high-dose therapy was approximately twice as high as among matched patients initiating modal-dose therapy. For adults 25 to 64 years of age, the absolute risk of suicidal behavior was far lower and the effective risk difference null.

The authors concluded that children and young adults initiating therapy with antidepressants at high-therapeutic doses seem to be at heightened risk of deliberate self-harm. The authors felt that recent meta-analyses showed modest efficacy of antidepressant therapy for youth, and mentioned separate evidence that antidepressant dose is generally unrelated to therapeutic efficacy. They suggest that their findings offer clinicians an additional incentive to avoid initiating pharmacotherapy at high-therapeutic doses and to closely monitor patients starting antidepressants, especially youth, for several months.

 Miller M, Swanson SA, Azrael D, Pate V, Sturmer T: Antidepressant Dose, Age, and the Risk of Deliberate Self-harm. JAMA Intern. Med. doi:10.1001/jamainternmed.2014.1053  [Published online April 28, 2014].

http://archinte.jamanetwork.com/article.aspx?articleid=1863925

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