Study: Monitoring Antidepressant Dose Appears Critical When Treating Children And Young Adults

Depression by the numbers…

We often speak about depression and treatment for major depressive disorder; however, we don’t always drill down into the numbers of people in the United States who have major depressive disorder. According to the National Institute of Mental Health (NIH):

  • Major Depressive Disorder is the leading cause of disability in the U.S. for ages 15-44
  • Major depressive disorder affects approximately 14.8 million American adults, or about 6.7 percent of the U.S. population age 18 and older in a given year.
  • While major depressive disorder can develop at any age, the median age at onset is 32
  • Major depressive disorder is more prevalent in women than in men

Additionally, the National Alliance on Mental Illness (NAMI) reports:

Studies have shown that on any single day (called “point prevalence” by epidemiologists) about 2 percent of school-aged children and about 8 percent of adolescents meet the criteria for major depression. Looking in the long term, the numbers are higher—for instance, one in five teens have experienced depression at some point. In primary care settings the rates of depression are higher still—as many as 28 percent for adolescents. Preschool depression has begun to attract interest in the literature but much more needs to be learned about how mood disorders may affect this age group.

Study highlights antidepressant prescription dose and suicidal behavior in teens and young adults

On April 28, 2014, the results of a new study were published online in the JAMA Internal Medicine journal: Antidepressant Dose, Age, and the Risk of Deliberate Self-harm. The study’s authors included Mathew Miller, MD, ScD  and Deborah Azrael, PhD of the Department of Health Policy and Management, Harvard School of Public Health, Sonja A. Swanson, ScM of the Department of Epidemiology, Harvard School of Public Health, and Virginia Pate, PhD and Til Sturmer, MD, ScD of the Department of Epidemiology Gillings School of Global Public Health, University of North Carolina.

This study is published 10 years after the US Food and Drug Administration warned the public that there was a suicide risk in children and teens being treated with selective serotonin reuptake inhibitors (SSRIs).

Study’s parameters

  • Researchers used data from a large prescription claims database.
  • 162,625 patients age 10 to 64 were studied.
  • Each patient had a diagnosis of depression.
  • Between 1998 and 2010 each patient began using an SSRI medication.
  • This analysis was confined to Celexa [20 milligrams per day is considered a normal dose], Zoloft [50 milligrams per day is considered a normal dose] and Prozax [20 milligrams per day is considered a normal dose]. These three products are the most commonly prescribed antidepressants.
  • The patients were separated into two groups: those who started with the recommended dose and those who were prescribed a higher than recommended dose
  • Any patient that was prescribed a combination of drugs was excluded from this study.
  • Participants’ medical records were reviewed by the researchers to discover how many, within a year of starting the medication, committed an act of self-harm. 

Study’s results

According to USA Today: “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.” 

Many scientists and medical doctors are weighing in on the study’s results. You can read more in our related articles below.

60 Minutes featured “Treating Depression: Is there a placebo effect?” on February 19, 2012

If you are having trouble viewing the video, you can see it here.

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