High-Dose Antidepressants Tied to Increased Self-Harm

Findings seen in children and young adults, compared to matched patients taking modal dose

TUESDAY, April 29, 2014 (HealthDay News) -- Children and young adults taking high-dose antidepressants are at heightened risk of deliberate self-harm, compared to those taking modal-therapeutic doses, according to a study published online April 28 in JAMA Internal Medicine.

Matthew Miller, M.D., Sc.D., from Harvard University in Boston, and colleagues analyzed population-based health care utilization data to propensity-match a cohort from 162,625 U.S. residents with depression (aged 10 to 64 years). The participants initiated antidepressant therapy with selective serotonin reuptake inhibitors at modal doses or higher from Jan. 1, 1998, through Dec. 31, 2010.

The researchers found that the rate of self-harm was nearly twice as high among children and adults (≤24 years of age) who initiated high-dose therapy compared to matched patients initiating modal-dose therapy (hazard ratio, 2.2; 95 percent confidence interval, 1.6 to 3.0). This is roughly equivalent to one additional event for every 150 patients treated with high-dose therapy. The absolute risk of suicidal behavior was far lower among adults aged 25 to 64 years, making the effective risk difference null (hazard ratio, 1.2; 95 percent confidence interval, 0.8 to 1.9).

"Considered in light of recent meta-analyses concluding that the efficacy of antidepressant therapy for youth seems to be modest, and separate evidence that antidepressant dose is generally unrelated to therapeutic efficacy, our 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 and colleagues conclude.

One author disclosed financial ties to the pharmaceutical industry.

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