Children and young adults who start antidepressant therapy at higher than modal doses appear to be at greater risk for suicidal behavior during the first 90 days of treatment, found a cohort study of 162 625 people aged 10 to 64 years with depression (Miller M et al. JAMA Intern Med. 2014;174:899-909). Modal doses for citalopram, sertraline, and fluoxetine were 20 mg/d, 50 mg/d, and 20 mg/d, respectively.
The rate of deliberate self-harm among individuals 24 years or younger who started antidepressant therapy at doses higher than modal doses (up to maximum daily doses of 40 mg/d, 200 mg/d, and 80 mg/d for citalopram, sertraline, and fluoxetine, respectively) was about twice as high as that in a matched group of patients who received modal-dose therapy. The authors suggested this corresponds to about 1 additional event of deliberate self-harm for every 150 patients treated with high-dose therapy. For adults 25 to 64 years old, there was no difference in risk for suicidal behavior.