High antidepressant dose linked to self harm in youths

When it comes to the link between

antidepressants and suicidal behavior in

young people, dose may matter quite a

bit, a new study suggests.

The Food and Drug Administration has for

years required antidepressants to carry

warnings that they may increase the risk of

suicidal thinking and behavior in children

and adults under age 25. The study,

published online Monday by the journal

JAMA Internal Medicine, finds the risk for

deliberate self harm doubles when

depressed young people start treatment

with higher-than-usual doses.

The finding is one more reason for doctors

and families to carefully consider how and

whether to use the medications in young

people, researchers say.

"One can quibble about how much benefit

there is at typical doses, and my sense is

that the benefit is modest at best," says

the study's lead author, Matthew Miller, a

physician at the Harvard School of Public

Health. "But there's no evidence that

higher initial doses are going to help more

than lower doses." Instead, he says, higher

doses may only add risk.

For the study, Miller and colleagues

looked at the health records of 162,625

privately insured people ages 10 to 64

treated for depression with three popular

antidepressants best known by the brand

names Celexa, Prozac and Zoloft.

They compared otherwise similar patients

— based on the intensity of their

depression symptoms, previous self harm

and other factors — who got either typical

starting doses or higher doses.

The typical starting doses were 20 mg. a

day for Celexa and Prozac and 50 mg. a

day for Zoloft.

Result: After a year, children, teens and

young adults were twice as likely to engage

in deliberate self harm if they started at

higher doses. Such acts were especially

common in the first three months. No

such link between starting dose and self

harm was found in adults 25 and up.

The number of young people who hurt

themselves was 142 out of 21,305. The

risk was 1.4% at typical doses and a 3.1%

at higher doses.

The reasons for any link between

antidepressants and self harm remain

unclear; it's also not known why it shows

up only in young people. One theory is

that the medications give young sufferers

new energy to carry out suicide plans;

another is that unpleasant side effects

trigger suicidal thoughts. Higher doses

might make such effects bigger, Miller and

his colleagues speculate.

The study adds support to guidelines that

call for starting antidepressants at low

doses, says David Brent, a professor of

psychiatry at the University of Pittsburgh

who co-wrote an accompanying editorial.

He notes that the study did not look at

whether dose escalations over time raised


Brent takes issue with Miller's statement

that antidepressants have "modest"

benefits in youths. For adults and youths

with depression of equal severity, he says,

benefits are comparable.

The National Institute of Mental Health

says the latest studies suggest "the benefits

of antidepressant medications likely

outweigh their risks to children and

adolescents with major depression." It

says that a combination of medication and

psychotherapy was most effective in one

major study.

The choices can be complex, Brent says:

"There is no one right thing to do. It's the

obligation of the physician to explain the

risks and benefits and for the family to

make the decision."

R. Scott Benson, a child psychiatrist in

Pensacola, Fla., says some children and

teens get put on antidepressants "in too

casual a way," without a thorough

evaluation of their problems. "We have to

make sure their level of depression is

serious enough to warrant treatment with

an antidepressant," he says. Benson is on

the communications committee of the

American Psychiatric Association.

Antidepressants are used by 3.7% of

children ages 12 to 17 and 6.1% of adults

ages 18 to 39, according to the federal

Centers for Disease Control and

Prevention. Use is higher in older adults.


Kofi Oppong Kyekyeku

I am a Ghanaian Broadcast Journalist/Writer who has an interest in General News, Sports, Entertainment, Health, Lifestyle and many more.

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