According to the Centers for Disease Control and Prevention, 1 in 10 US adults suffer from depression. In addition, a number of children suffer from it. Many of these individuals take antidepressants. According to a new study, children and young adults who take antidepressants at a high dose are at increased risk of suicide. The findings were published online on April 28 in the journal JAMA Internal Medicine by researchers at the University of Pittsburgh and the University of Chicago.
The researchers conducted a meta-analysis of randomized clinical trials to evaluate the risk of suicide risk of individuals taking antidepressants by age group. A meta-analysis is a compilation of data from a number of trials to clarify a point, in this case, suicide risk by age group. They noted that to the best of their knowledge, no study to date has evaluated whether the risk of suicidal behavior is related to antidepressant dose, and if so, whether the risk depends on the individual’s age. The analysis included data from 162,625 US residents with depression aged 10 through 64 years who began taking antidepressant therapy with selective serotonin reuptake inhibitors (SSRIs) at the normally-prescribed does or higher from January 1, 1998, through December 31, 2010.
The main outcome measurement of the study was based on the International Classification of Diseases, Ninth Revision (ICD-9)external cause of injury codes E950.x-E958.x (deliberate self-harm). The investigators found that the rate of deliberate self-harm among children and adults 24 years of age or younger who began taking high-dose antidepressant therapy was approximately twice as high as among matched individuals taking the normally-prescribed dosage (2.2-fold increased risk). This finding translated into approximately 1 additional event for every 150 such patients treated with high-dose (instead of normal-dose) therapy. For adults 25 to 64 years of age, the absolute risk of suicidal behavior was far lower and the effective risk difference was none.
The authors concluded that children and young adults who begin treatment with antidepressants at high-therapeutic (rather than normal-therapeutic) doses appear to be at increased risk of deliberate self-harm. They noted that recent meta-analyses have found that the efficacy of antidepressant therapy for this age group appears to be modest, and that other evidence suggests that antidepressant dose is generally unrelated to therapeutic effectiveness; therefore, their findings offer healthcare professionals additional incentive to avoid initiating drug treatment at high-therapeutic doses and to closely monitor patients starting antidepressants, especially youth, for several months.