In this methodologically exemplar pharmacoepidemiological study by Miller et al,1 data on patients with depression were assessed for prospective risk for deliberate self-harm (DSH; ie, suicide attempt) according to whether the patients had been initiated on therapy with the modal dose vs higher than modal dose of antidepressant. Using propensity-matched analysis, initiation at a higher than modal dose of antidepressant resulted in a 2-fold increased risk of deliberate self-harm in patients aged 10 to 24 years, especially in the first 3 months of treatment, while there was no such effect found in those aged 25 to 64 years.
Brent DA, Gibbons R. Initial Dose of Antidepressant and Suicidal Behavior in YouthStart Low, Go Slow. JAMA Intern Med. 2014;174(6):909-911. doi:10.1001/jamainternmed.2013.14016