SSRI prescribing rates and adolescent suicide: Is the black box hurting or helping?

Although unintended, the FDA's black-box warning has led to a decrease in the pharmacological treatment of pediatric depression and a decrease in the diagnosis of pediatric depression. At the same time, we have seen the largest increase in child, adolescent, and teen suicide since the CDC began recording these data in 1979. In the event that these results are further confirmed by 2005 suicide rate data, it becomes clear that the black-box warning should be reconsidered and replaced by an effort to improve diagnosis of major depression, improved access to treatment, and more careful monitoring of treatment with antidepressants where indicated. A black-box warning has only been rescinded once in history, for the drug omeprazole in 2003, but given the mortality of youth suicide and the need to reverse these alarming trends and loss of life, such a step may prove necessary for antidepressant labeling in children and young adults.