High initial doses of antidepressants may double suicide risk in teens

Young people who start taking antidepressants at higher-than-average doses may be twice as likely to commit suicide, especially in the first three months of treatment, as those who begin treatment with customary doses, according to a new study led by Harvard School of Public Health (HSPH).

Earlier studies found that taking selective serotonin reuptake inhibitor antidepressants (SSRIs) increased suicidal thinking and behavior in young people, which prompted the U.S. Food and Drug Administration to issue warnings about the drugs 10 years ago. The new study suggests that it may be the initial dose of such drugs that matters most.

The study, “Antidepressant Dose, Age, and the Risk of Deliberate Self-harm,” published online April 28, 2014 in JAMA Internal Medicine, was led by injury prevention expert Matthew Miller, associate professor of health policy and management at HSPH. Looking at data from 162,625 young people treated for depression with SSRIs between 1998 and 2010, Miller and colleagues found that there was roughly one additional suicide attempt for every 150 young people who started with higher doses of antidepressants.