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Clinical Trials Update
June 25, 2014

Youth, High-Dose Antidepressants, and Self-harm

JAMA. 2014;311(24):2472. doi:10.1001/jama.2014.7643

Children and young adults who start antidepressant therapy at higher than modal doses appear to be at greater risk for suicidal behavior during the first 90 days of treatment, found a cohort study of 162 625 people aged 10 to 64 years with depression (Miller M et al. JAMA Intern Med. 2014;174[6]:899-909). Modal doses for citalopram, sertraline, and fluoxetine were 20 mg/d, 50 mg/d, and 20 mg/d, respectively.

The rate of deliberate self-harm among individuals 24 years or younger who started antidepressant therapy at doses higher than modal doses (up to maximum daily doses of 40 mg/d, 200 mg/d, and 80 mg/d for citalopram, sertraline, and fluoxetine, respectively) was about twice as high as that in a matched group of patients who received modal-dose therapy. The authors suggested this corresponds to about 1 additional event of deliberate self-harm for every 150 patients treated with high-dose therapy. For adults 25 to 64 years old, there was no difference in risk for suicidal behavior.