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High-Dose Antidepressants May Double Self-Harm Risk in Kids


April 29, 2014 — The use of high-dose antidepressants in children aged 10-24 has been linked to at least a doubled increased risk of deliberate self-harm (suicidal) behavior, according to a study published in JAMA Internal Medicine.

The study was led by Dr. Matthew Miller of the Harvard School of Public Health and colleagues. They analyzed data on over 162,000 people between the ages of 10 and 64 who were diagnosed with depression and initiated treatment with Celexa (citalopram), Prozac (fluoxetine), or Zoloft (sertraline). Patients were monitored at one month, three months, and one year.

After controlling for a number of confounding factors, researchers found that children and adolescents in the 10-24 year-old age group were 2.2-times more likely to engage in deliberate self-harm if they began treatment at a higher-than-normal dose — especially in the first three 90 days of treatment. The “modal dose” was defined as 20-mg/day for Celexa, 50-mg/day for Zoloft, and 20-mg/day for Prozac.

The researchers warned:

“In our primary analysis of the 10- to 24-year-old cohort, for every 1000 patients initiating high-dose therapy there were approximately 7 (7.3) more [deliberate self-harm] events over the first 90 days of treatment among high-dose initiators compared with modal dose initiators.”

Experts have known for over a decade that antidepressants can increase the risk of suicidal behavior in adolescents, although no one knows exactly why. The FDA required a Boxed Warning on the label for all SSRI antidepressants in 2004. The Centers for Disease Control (CDC) estimated that from 2005-2008, one in ten Americans over the age of 12 were on an antidepressant medication.

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