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What if aspirin sometimes made your head throb more, cough syrup started you hacking, or antacids churned up your heartburn?

At least one medicine can have nearly the opposite of their intended effect—SSRIs, a common type of antidepressants. In certain cases, these drugs actually increase the chances you’ll want to hurt yourself. The younger you are and the higher your dosage, the greater your risk, a new study highlights. [Tweet this!]

Doctors have known about this effect for at least a decade. In fact, antidepressants such as Prozac, Zoloft, and Paxil carry a serious warning on the label mentioning the risk of suicidal thoughts and behaviors in kids, teens, and young adults.

The new study, published in JAMA Internal Medicine, puts some hard numbers on the hazards. Researchers compared people who started off on low doses of the drugs to those who took higher doses (but still within the range doctors commonly prescribe).

For children and adults age 24 and younger, those on higher doses were twice as likely to deliberately hurt themselves. This added up to about one additional instance of self-harm for every 150 people taking the drug. (Adults older than 24—study participants ranged up to age 65—didn’t face the same threat.)

The study wasn’t designed to find out why this happens, says study author Matthew Miller, M.D., Sc.D., of the Harvard School of Public Health. But scientists have a few theories.

“One of the unique side effects in the youngest patients treated with antidepressants is disinhibition, meaning acting on impulses one would usually resist,” says Rachel E. Dew, M.D., M.HSc., a psychiatrist at Duke Medicine. So while your depression could cause your suicidal feelings, the medication can rob you of the power to resist those urges.

These results don’t mean you shouldn’t seek treatment for depression. In fact, they make getting help early even more important, says Cleveland Clinic psychiatrist Joseph Austerman, D.O. Mild symptoms—such as persistent sadness, changes in sleep or appetite, and not finding pleasure in things you used to enjoy—can usually be treating with counseling alone. And if your doctor does advise medication?

1. Start low. Higher beginning doses increase your risk for a wide range of side effects. Plus, they don’t work better or faster at treating depression, Miller says. Ask your doctor to prescribe you the lowest dose possible.

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2. Check with your family. A personal or family history of bipolar disorder may increase your odds of wanting to hurt yourself. And if your parents or siblings had a negative experience with antidepressants, your risk may be higher too, Austerman says. Tell your doctor if any of this applies to you.

3. Ask about follow-up. Your doctor should keep close watch on you, especially during the first three months (that’s when most of the problems in the study occurred). Set a schedule for checking in, either by phone or in person, Austerman advises.

4. Don’t wait. “I tell my young patients to think of suicidal thoughts or any thoughts of self-harm as emergencies, like if they saw a fire,” Dew says. “Depression makes them think no one will care, but I emphasize they need to tell someone right away.”

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