Do SSRI Doses Affect Suicide Risk?
Written by Editor   
Wednesday, April 30, 2014 01:20 PM

By the time you read this, there's a good chance you will have seen articles in consumer media saying that high antidepressant doses in teens and young adults increase their risk of suicide. Watch out, it's not that simple.

The study on which those articles would be based is actually a pretty good one.  It found that rates of "deliberate self-harm" (including suicide attempts as well as lesser self-injuries such as cutting) were about twice as highin those in the 10 to 24 age group who were started on selective serotonin reuptake inhibitor (SSRI) antidepressants at relatively high doses, compared with those taking "modal" or "below-modal" doses Moreover, that hazard ratio reflected adjustment for a self-harm propensity score, which the authors calculated from a set of known risk factors that were tallied in the claims data.

There was no significant increase in self-harm risks in adults 25 and older who were taking higher-than-usual doses. So the increase in apparent risk in the younger patients looks pretty damning. 

But not proven. Far from it, in fact.

Note what was not included in the propensity score because the claims data did not include it:

  • Physicians' notes on why they prescribed high (or low) doses
  • Depression severity at SSRI initiation
  • Suicidality at SSRI initiation

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