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 Youth: Start Low, Go Slow. JAMA Intern Med. 2014;174(6):909–911. doi:10.1001/jamainternmed.2013.14016
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