Initial dose of antidepressant and suicidal behavior in youth: Start low, go slow.

In this methodologically exemplar pharmacoepidemiological study by Miller et al,1 data on patients with depression were assessed for prospective risk for deliberate self-harm (DSH; ie, suicide attempt) according to whether the patients had been initiated on therapy with the modal dose vs higher than modal dose of antidepressant. One of the many strengths of this study was that the outcome was actual suicidal behavior rather than the more commonly used outcome Òsuicidal events,Ó which includes worsening in suicidal ideation, such as Òthoughts of deathÓ as well as actual suicidal behavior.