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Higher Doses of Antidepressants & Suicidal Behavior

They were twice as likely to try to hurt themselves if they were prescribed more than recommended dose

WebMD News from HealthDay

By Brenda Goodman

HealthDay Reporter

MONDAY, April 28, 2014 (HealthDay News) -- When prescribing antidepressants for teens and young adults, doctors should not start with high doses of the drugs because it might raise the risk of suicidal behavior, new research suggests.

The study, which was published online April 28 in the journal JAMA Internal Medicine, found that younger patients who began treatment with higher-than-recommended doses of antidepressants were more than twice as likely to try to harm themselves as those who were initially treated with the same drugs at lower, recommended doses.

"If I were a parent, I definitely wouldn't want my child to start on a higher dose of these drugs," said study author Dr. Matthew Miller, associate director of the Injury Control Research Center at the Harvard School of Public Health in Boston.

The research is likely to inform an ongoing debate in psychiatry -- whether or not it's safe to prescribe antidepressants to children and young adults.

In 2004, the U.S. Food and Drug Administration issued a public warning about the risk of suicide in kids and teens treated with a class of antidepressants called selective serotonin reuptake inhibitors (SSRIs).

The warning followed a government review that found youngsters who took the drugs were twice as likely to try to harm themselves as those who took inactive "placebo" pills. The agency expanded its black box warning on the drugs in 2007 to include adults younger than age 25.

More recent research has challenged the idea that antidepressants are dangerous for kids and young adults, however.

A review published in 2007 in the Journal of the American Medical Association concluded that the benefits of taking antidepressants outweighed the potential harms to teens and young adults.

Another study published in 2007 in the American Journal of Psychiatry showed that while youth prescriptions for SSRIs have dropped by 22 percent since the FDA's black box warning, suicides in children and teens have increased. Some experts cite the finding as proof that the FDA's warning was short-sighted and the drugs actually prevent youth suicides.

But no studies have looked at suicide risk by drug dosage, as the latest study did.

For the research, the study authors pulled information from a large prescription claims database. The study included more than 162,000 patients aged 10 to 64 with a diagnosis of depression who started taking an SSRI medication between 1998 and 2010.

Researchers restricted their analysis to three of the most commonly prescribed antidepressants, Celexa, Zoloft and Prozac. And they separated users into those who started at the recommended dosages of those medications, or those who were prescribed higher-than-recommended doses of the drugs.

The normal doses were 20 milligrams per day for Celexa, 50 milligrams per day for Zoloft and 20 milligrams per day for Prozac. Patients who were initially prescribed more than one drug were excluded from the study.

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