Teenaged, Depressed, and Treatment Resistant: What Predicts Self-Harm?

Abstract

Self-harm affects thousands of depressed teenagers each year. A careful meta-analysis of pediatric antidepressant trials by the Food and Drug Administration (FDA) showed a higher rate of spontaneously reported suicidal behaviors in adolescents randomly assigned to antidepressants versus placebo. The publicity about this relationship and the subsequent FDA black box warning was followed by a decrease in antidepressant use (1) and a possible increase in adolescent suicides. Whether the increase is real and sustained is still unclear (2-4). Data that can identify who is at risk for an increase in reported self-harm with medication are difficult to find. Standardized systematic assessment of suicidal events in adolescent trials have only recently been developed (5), and adolescents with a history of self-harm behaviors, the ones with greatest risk, have usually been excluded from clinical trials.