Tag Archives: Teens and suicide

Harvard study: High doses of antidepressants appear to increase risk of self-harm in children and young adults

29 Apr

People of all ages may have feelings of profound sadness, loss, and depression. There is no one on earth, despite what the ads attempt to portray, who lives a perfect life. Every life has flaws and blemishes, it is just that some cope better than others. For every person who lives to a ripe old age, during the course of that life they may encounter all types of loss from loss of a loved one through death, divorce or desertion, loss of job, financial reverses, illness, dealing with A-holes and twits, plagues, pestilence, and whatever curse can be thrown at a person. The key is that they lived THROUGH whatever challenges they faced AT THAT MOMENT IN TIME. Woody Allen said something like “90% of life is simply showing up.” Let moi add a corollary, one of the prime elements of a happy life is to realize that whatever moment you are now in, it will not last forever and that includes moments of great challenge. A person does not have to be religious to appreciate the story of Job. The end of the story is that Job is restored. He had to endure much before the final victory, though.

Medical Press reported in the article, High doses of antidepressants appear to increase risk of self-harm in children young adult:

Children and young adults who start antidepressant therapy at high doses, rather than the “modal” [average or typical] prescribed doses, appear to be at greater risk for suicidal behavior during the first 90 days of treatment.
A previous meta-analysis by the U.S. Food and Drug Administration (FDA) of antidepressant trials suggested that children who received antidepressants had twice the rate of suicidal ideation and behavior than children who were given a placebo. The authors of the current study sought to examine suicidal behavior and antidepressant dose, and whether risk depended on a patient’s age.
The study used data from 162,625 people (between the ages of 10 to 64 years) with depression who started antidepressant treatment with a selective serotonin reuptake inhibitor at modal (the most prescribed doses on average) or at higher than modal doses from 1998 through 2010.
The rate of suicidal behavior (deliberate self-harm or DSH) among children and adults (24 years or younger) who started antidepressant therapy at high doses was about twice as high compared with a matched group of patients who received generally prescribed doses. The authors suggest this corresponds to about one additional event of DSH for every 150 patients treated with high-dose therapy. For adults 25 to 64 years old, the difference in risk for suicidal behavior was null. The study does not address why higher doses might lead to higher suicide risk….
“Their findings suggest that higher than modal initial dosing leads to an increased risk for DSH and adds further support to current clinical recommendations to begin treatment with lower antidepressant doses. While initiation at higher than modal doses of antidepressants may be deleterious, this study does not address the effect of dose escalation,” they continue.
“Moreover, while definitive studies on the impact of dose escalation in the face of nonresponse remain to be done, there are promising studies that suggest in certain subgroups, dose escalation can be of benefit. Finally it should be noted that in this study, there was no pre-exposure to post-exposure increase in suicidal behavior after the initiation of antidepressants in youth treated at the modal dosage,” they conclude. http://medicalxpress.com/news/2014-04-high-doses-antidepressants-self-harm-children.html

Citation:

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Original Investigation|April 28, 2014
Antidepressant Dose, Age, and the Risk of Deliberate Self-harm
ONLINE FIRST
Matthew Miller, MD, ScD1; Sonja A. Swanson, ScM2; Deborah Azrael, PhD1; Virginia Pate, PhD, PhD3; Til Stürmer, MD, ScD3
[+] Author Affiliations
JAMA Intern Med. Published online April 28, 2014. doi:10.1001/jamainternmed.2014.1053
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ABSTRACT
ABSTRACT | METHODS | RESULTS | DISCUSSION | CONCLUSIONS | ARTICLE INFORMATION | REFERENCES
Importance A comprehensive meta-analysis of randomized trial data suggests that suicidal behavior is twice as likely when children and young adults are randomized to antidepressants compared with when they are randomized to placebo. Drug-related risk was not elevated for adults older than 24 years. To our knowledge, no study to date has examined whether the risk of suicidal behavior is related to antidepressant dose, and if so, whether risk depends on a patient’s age.
Objective To assess the risk of deliberate self-harm by antidepressant dose, by age group.
Design, Setting, and Participants This was a propensity score–matched cohort study using population-based health care utilization data from 162 625 US residents with depression ages 10 to 64 years who initiated antidepressant therapy with selective serotonin reuptake inhibitors at modal or at higher than modal doses from January 1, 1998, through December 31, 2010.
Main Outcomes and Measures International Classification of Diseases, Ninth Revision (ICD-9) external cause of injury codes E950.x-E958.x (deliberate self-harm).
Results The rate of deliberate self-harm among children and adults 24 years of age or younger who initiated high-dose therapy was approximately twice as high as among matched patients initiating modal-dose therapy (hazard ratio [HR], 2.2 [95% CI, 1.6-3.0]), corresponding to approximately 1 additional event for every 150 such patients treated with high-dose (instead of modal-dose) therapy. For adults 25 to 64 years of age, the absolute risk of suicidal behavior was far lower and the effective risk difference null (HR, 1.2 [95% CI, 0.8-1.9]).
Conclusions and Relevance Children and young adults initiating therapy with antidepressants at high-therapeutic (rather than modal-therapeutic) doses seem to be at heightened risk of deliberate self-harm. Considered in light of recent meta-analyses concluding that the efficacy of antidepressant therapy for youth seems to be modest, and separate evidence that antidepressant dose is generally unrelated to therapeutic efficacy, our findings offer clinicians an additional incentive to avoid initiating pharmacotherapy at high-therapeutic doses and to closely monitor patients starting antidepressants, especially youth, for several months.

Here is the press release from Harvard:

PUBLIC RELEASE DATE:
28-Apr-2014

Contact: Marge Dwyer
mhdwyer@hsph.harvard.edu
617-432-8416
The JAMA Network Journals
High doses of antidepressants appear to increase risk of self-harm in children young adult
Bottom Line:
Children and young adults who start antidepressant therapy at high doses, rather than the “modal” [average or typical] prescribed doses, appear to be at greater risk for suicidal behavior during the first 90 days of treatment.
Author:
Matthew Miller, M.D., Sc.D., of the Harvard School of Public Health, Boston, and colleagues.
Background:
A previous meta-analysis by the U.S. Food and Drug Administration (FDA) of antidepressant trials suggested that children who received antidepressants had twice the rate of suicidal ideation and behavior than children who were given a placebo. The authors of the current study sought to examine suicidal behavior and antidepressant dose, and whether risk depended on a patient’s age.
How the Study Was Conducted:
The study used data from 162,625 people (between the ages of 10 to 64 years) with depression who started antidepressant treatment with a selective serotonin reuptake inhibitor at modal (the most prescribed doses on average) or at higher than modal doses from 1998 through 2010.
Results: The rate of suicidal behavior (deliberate self-harm or DSH) among children and adults (24 years or younger) who started antidepressant therapy at high doses was about twice as high compared with a matched group of patients who received generally prescribed doses. The authors suggest this corresponds to about one additional event of DSH for every 150 patients treated with high-dose therapy. For adults 25 to 64 years old, the difference in risk for suicidal behavior was null. The study does not address why higher doses might lead to higher suicide risk.
Discussion: “Considered in light of recent meta-analyses concluding that the efficacy of antidepressant therapy for youth seems to be modest, and separate evidence that dose is generally unrelated to the therapeutic efficacy of antidepressants, our findings offer clinicians an additional incentive to avoid initiating pharmacotherapy at high-therapeutic doses and to monitor all patients starting antidepressants, especially youth, for several months and regardless of history of DSH.”
(JAMA Intern Med. Published online April 28, 2014. doi:10.1001/jamainternmed.2014.1053. Available pre-embargo to the media at http://media.jamanetwork.com.)
Editor’s Note: Authors made a conflict of interest and funding disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
Commentary: Initial Dose of Antidepressants, Suicidal Behavior in Youth
In a related commentary, David A. Brent, M.D., of the University of Pittsburgh, and Robert Gibbons, Ph.D., of the University of Chicago, write: “In summary Miller et al are to be commended on a thoughtful and careful analysis of the effects of initiating antidepressants at higher than modal doses.”
“Their findings suggest that higher than modal initial dosing leads to an increased risk for DSH and adds further support to current clinical recommendations to begin treatment with lower antidepressant doses. While initiation at higher than modal doses of antidepressants may be deleterious, this study does not address the effect of dose escalation,” they continue.
“Moreover, while definitive studies on the impact of dose escalation in the face of nonresponse remain to be done, there are promising studies that suggest in certain subgroups, dose escalation can be of benefit. Finally it should be noted that in this study, there was no pre-exposure to post-exposure increase in suicidal behavior after the initiation of antidepressants in youth treated at the modal dosage,” they conclude.
(JAMA Intern Med. Published online April 28, 2014. doi:10.1001/jamainternmed.2013.14016. Available pre-embargo to the media at http://media.jamanetwork.com.)
Editor’s Note: Authors made conflict of interest and funding disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
###
Media Advisory:
To contact author Matthew Miller, M.D., Sc.D., call Marge Dwyer at 617-432-8416 or email mhdwyer@hsph.harvard.edu. To contact commentary author David A. Brent, M.D., call Gloria Kreps at 412-586-9764 or email krepsga@upmc.edu.

What Should You Do if You Know Someone Who Thinking About Suicide?

If you are thinking of suicide or you know someone who is thinking about suicide, GET HELP, NOW!!!! The Suicide Prevention Resource Center http://www.sprc.org/basics/roles-suicide-prevention has some excellent advice about suicide prevention http://www.sprc.org/basics/roles-suicide-prevention

Resources:

Teen’s Health’s Suicide http://kidshealth.org/teen/your_mind/feeling_sad/suicide.html

American Academy of Adolescent Psychiatry http://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/Facts_for_Families_Pages/Teen_Suicide_10.aspx
Suicide Prevention Resource Center http://www.sprc.org/basics/roles-suicide-prevention

Teen Depression http://helpguide.org/mental/depression_teen.htm

Jared Story.Com http://www.jaredstory.com/teen_epidemic.html
CNN Report about suicide http://www.cnn.com/2009/LIVING/10/20/lia.latina.suicides/index.html
American Foundation for Suicide Prevention
http://www.afsp.org This group is dedicated to advancing the knowledge of suicide and the ability to prevent it.

SA\VE – Suicide Awareness\Voices of Education
http://www.save.org SA\VE offers information on suicide prevention. Call (800) SUICIDE

Youth Suicide Prevention
About.Com’s Depression In Young Children http://depression.about.com/od/child/Young_Children.htm

Psych Central’s Depression In Young Children http://depression.about.com/od/child/Young_Children.htm

Psychiatric News’ Study Helps Pinpoint Children With Depression
http://psychnews.psychiatryonline.org/newsarticle.aspx?articleid=106034

Family Doctor’s What Is Depression? http://familydoctor.org/familydoctor/en/diseases-conditions/depression.html

WebMD’s Depression In Children http://www.webmd.com/depression/guide/depression-children

Healthline’s Is Your Child Depressed? http://www.healthline.com/hlvideo-5min/how-to-help-your-child-through-depression-517095449

Medicine.Net’s Depression In Children http://www.onhealth.com/depression_in_children/article.htm

If you or your child needs help for depression or another illness, then go to a reputable medical provider. There is nothing wrong with taking the steps necessary to get well.

Related:
University of California, San Francisco study identifies most common reasons for children’s mental health hospitalizations https://drwilda.com/tag/depression/

GAO report: Children’s mental health services are lacking https://drwilda.com/2013/01/12/gao-report-childrens-mental-health-services-are-lacking/

Schools have to deal with depressed and troubled children https://drwilda.com/2011/11/15/schools-have-to-deal-with-depressed-and-troubled-children/

Where information leads to Hope. © Dr. Wilda.com

Dr. Wilda says this about that ©

Blogs by Dr. Wilda:
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Study: Current therapies may not be effective in preventing teen suicide, but targeted treatment helps

8 Jan

People of all ages may have feelings of profound sadness, loss, and depression. There is no one on earth, despite what the ads attempt to portray, who lives a perfect life. Every life has flaws and blemishes, it is just that some cope better than others. For every person who lives to a ripe old age, during the course of that life they may encounter all types of loss from loss of a loved one through death, divorce or desertion, loss of job, financial reverses, illness, dealing with A-holes and twits, plagues, pestilence, and whatever curse can be thrown at a person. The key is that they lived THROUGH whatever challenges they faced AT THAT MOMENT IN TIME. Woody Allen said something like “90% of life is simply showing up.” Let moi add a corollary, one of the prime elements of a happy life is to realize that whatever moment you are now in, it will not last forever and that includes moments of great challenge. A person does not have to be religious to appreciate the story of Job. The end of the story is that Job is restored. He had to endure much before the final victory, though.

Why Do Teens Attempt Suicide?

The American Academy of Adolescent Psychiatry has some excellent suicide resources

Suicides among young people continue to be a serious problem. Each year in the U.S., thousands of teenagers commit suicide. Suicide is the third leading cause of death for 15-to-24-year-olds, and the sixth leading cause of death for 5-to-14-year-olds.

Teenagers experience strong feelings of stress, confusion, self-doubt, pressure to succeed, financial uncertainty, and other fears while growing up. For some teenagers, divorce, the formation of a new family with step-parents and step-siblings, or moving to a new community can be very unsettling and can intensify self-doubts. For some teens, suicide may appear to be a solution to their problems and stress.

Sometimes, people see suicide as an answer to their problems. All of us must stress that suicide is always the WRONG answer to what in all likelihood is a transitory situation.

What are the Warning Signs of Suicide?

According to Teen’s Health there are some suicide warning signs

Warning Signs

There are often signs that someone may be thinking about or planning a suicide attempt. Here are some of them:

talking about suicide or death in general

talking about “going away”

referring to things they “won’t be needing,” and giving away possessions

talking about feeling hopeless or feeling guilty

pulling away from friends or family and losing the desire to go out

having no desire to take part in favorite things or activities

having trouble concentrating or thinking clearly

experiencing changes in eating or sleeping habits

engaging in self-destructive behavior (drinking alcohol, taking drugs, or cutting, for example)

These are signs that indicate a person may be depressed.

According to JaredStory.com the primary cause of suicide is depression.

# 1 CAUSE OF SUICIDE: UNTREATED DEPRESSION

It can be very hard to diagnose depression. There are many different kinds of depression and not all people will have the same symptoms, or have them to the same degree. Here are some symptoms to watch for and if they last more than a few weeks, a doctor or psychiatrist should be consulted.

Persistent sad or “empty” mood

Feeling hopeless, helpless, worthless

pessimistic and or guilty

Substance abuse

Fatigued or loss of interest in ordinary activities

Disturbances in eating and sleeping patterns

Irritability, increased crying, anxiety and panic attacks, (Post Traumatic Stress Disorder)

Difficulty concentrating, remembering or making decisions

Thoughts of suicide; suicide plans or attempts

Persistent physical symptoms or pains that do not respond to treatment

The site also lists events that might trigger depression in a person.

A death of a family member or close friend – which could include a fellow student from school

An assault, car accident or painful physical event – which could include physical bullying

Mental, or emotional event – which could include non-physical bullying

Marriage breakup, or love lost suddenly – which could include “breaking up” with a girlfriend or boyfriend

Constant physical, mental, or emotional pain that goes on for a length of time – which includes constant bullying that is not intervened, resolved or stopped entirely

Major Financial setback – which includes a teenager who may have lost a job

Something “embarrassing” happens – as an example; getting kicked off a football team or a public insult by a teacher or popular student; bullying

Failing an important exam a school – not a normal trigger unless the exam was life changing and the individual is under a lot of stress

A best friend moves out of town – especially true for teenagers who are being bullied and have very few friends as it is

If you notice these signs, the key is to get help for yourself or a friend. The type of treatment will depend upon the underlying symptoms.

Benedict Carey reports in the New York Times article, Study Questions Effectiveness of Therapy for Suicidal Teenagers:

Most adolescents who plan or attempt suicide have already received at least some mental health treatment, raising questions about the effectiveness of current approaches to helping troubled youths, according to the largest in-depth analysis to date of suicidal behaviors in American teenagers.

The study, in the journal JAMA Psychiatry, found that 55 percent of suicidal teenagers had received some therapy before they thought about suicide, planned it or tried to kill themselves, contradicting the widely held belief that suicide is due in part to a lack of access to treatment.

The findings, based on interviews with a nationwide sample of more than 6,000 teenagers and at least one parent of each, linked suicidal behavior to complex combinations of mood disorders like depression and behavior problems like attention-deficit and eating disorders, as well as alcohol and drug abuse.

The study found that about one in eight teenagers had persistent suicidal thoughts at some point, and that about a third of those who had suicidal thoughts had made an attempt, usually within a year of having the idea.

Previous studies have had similar findings, based on smaller, regional samples. But the new study is the first to suggest, in a large nationwide sample, that access to treatment does not make a big difference. ..

Over all, about one-third of teenagers with persistent suicidal thoughts went on to make an attempt to take their own lives.

Almost all of the suicidal adolescents in the study qualified for some psychiatric diagnosis, whether depression, phobias or generalized anxiety disorder. Those with an added behavior problem — attention-deficit disorder, substance abuse, explosive anger — were more likely to act on thoughts of self-harm, the study found.

Doctors have tested a range of therapies to prevent or reduce recurrent suicidal behaviors, with mixed success. Medications can ease depression, but in some cases they can increase suicidal thinking. Talk therapy can contain some behavior problems, but not all.

One approach, called dialectical behavior therapy, has proved effective in reducing hospitalizations and suicide attempts in, among others, people with borderline personality disorder, who are highly prone to self-harm.

But suicidal teenagers who have a mixture of mood and behavior issues are difficult to reach. In one 2011 study, researchers at George Mason University reduced suicide attempts, hospitalizations, drinking and drug use among suicidal adolescent substance abusers. The study found that a combination of intensive treatments — talk therapy for mood problems, family-based therapy for behavior issues and patient-led reduction in drug use — was more effective than regular therapies. http://www.nytimes.com/2013/01/09/health/gaps-seen-in-therapy-for-suicidal-teenagers.html?hp&_r=0

See, A Tragedy and a Mystery http://harvardmagazine.com/2011/01/tragedy-and-mystery

What Should You Do if You Know Someone Who Thinking About Suicide?

If you are thinking of suicide or you know someone who is thinking about suicide, GET HELP, NOW!!!! The Suicide Prevention Resource Center has some excellent advice about suicide prevention

Resources

Teen’s Health’s Suicide

American Academy of Adolescent Psychiatry

Suicide Prevention Resource Center

Teen Depression

Jared Story.Com

CNN Report about suicide

American Foundation for Suicide Prevention
http://www.afsp.org This group is dedicated to advancing the knowledge of suicide and the ability to prevent it.

SA\VE – Suicide Awareness\Voices of Education
http://www.save.org SA\VE offers information on suicide prevention. Call (800) SUICIDE

Youth Suicide Prevention

Where information leads to Hope. ©                 Dr. Wilda.com

Dr. Wilda says this about that ©

Blogs by Dr. Wilda:

COMMENTS FROM AN OLD FART©                         http://drwildaoldfart.wordpress.com/

Dr. Wilda Reviews ©                                                http://drwildareviews.wordpress.com/

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