A new study finds the risk for deliberate self harm doubles when depressed young people start treatment with higher than usual doses of antidepressant medications.
The new 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.
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 risk for self harm was 1.4% at typical doses and a 3.1% at higher doses.
The findings were published in the journal JAMA Internal Medicine.