Proper studies of selective serotonin reuptake inhibitors are needed for youth with depression.

270 E vidence of a possible association between the use of selective serotonin reuptake inhibitors (SSRIs) and suicide in youth presents a vexing problem for clini-cians, youth and their families. Are these medications the most effective treatment for major depression in children, adolescents and young adults? Do SSRIs carry a greater risk for suicide than no treatment or alternative treatments such as other antidepressants or specific psychotherapies? In this issue, Barbui and colleagues 1 report the results of a meta-analysis of 8 large-scale observational studies that compared the risk of suicide among patients with depression who received SSRIs and those with no exposure to antidepres-sants. In contrast to the results reported from a meta-analysis performed by the US Food and Drug Administration (FDA), which concluded that there was a neutral effect of SSRIs on the risk of suicide among adults aged 25–64 years, Barbui and colleagues report a protective effect of SSRIs in this age group. Furthermore, although the FDA concluded that there was increased risk of suicidality associated with the use of antidepressants among youth aged 18–24 years and extended the " black-box " warning for use of antidepressants to this age group, Barbui and colleagues found a beneficial effect. Of interest , a study by Gibbons and colleagues, 2 which was included in the analysis by Barbui and colleagues, included a large sample of patients with major depression from Veter-ans' Affairs centres. This study specifically examined the effect of SSRIs in patients aged 18–25 years. Gibbons and colleagues found a protective effect of antidepressants in terms of lower rates of suicide attempts compared to patients who received no treatment. They also reported a protective effect of SSRIs when the risk of suicide was compared in the same cohort before and during treatment. Barbui and colleagues found a higher rate of suicide attempts and completions among adolescents and a lower rate among adults whose depression was treated with SSRIs. These results are reassuring for adults and their clinicians and families , but worrisome for adolescents and their clinicians and families. However, we must reconcile these findings with other conflicting data. Sondergard and colleagues 3 noted that none of the 42 youth in Denmark aged 10–17 years who committed suicide between 1995 and 1999 had taken an SSRI within 2 weeks before their suicide. If SSRIs increase the risk of suicide, it is unclear why these drugs are so rarely …