The modal daily doses were 20 mg/d for citalopram hydrobromide, 50 mg/d for sertraline hydrochloride and 20 mg/d for fluoxetine hydrochloride. Those receiving doses lower than these or doses in excess of the recommended maximum therapeutic doses were excluded from the analyses.
The findings of this study add further support to current clinical recommendations to begin treatment with lower antidepressant doses, and to closely monitor patients starting antidepressants [especially youth] for several months. It does not however address dose escalation, which may be of benefit in certain subgroups.
The authors of a related commentary question why 18% of patients were initially treated with high doses of antidepressants, contrary to clinical guidelines, and suggest there may have been something different about these patients that may have also put them at a greater risk of deliberate self-harm, such as a history of treatment non-response. It is also possible that those receiving a higher dose suffered from more adverse effects and were more likely to discontinue treatment, and this itself could have increased the risk for harm.