Introduction
!e suicide rate in the United States fell approximately
14 percent from 1985 to 1999.1 !e decline
was largely attributed to the increased use of
selective serotonin reuptake inhibitor (SSRI)
antidepressants during this same period.1
In 2004,
however, labeling for SSRIs, as well as all prescription
antidepressants in the United States, began to
include warnings of an increased risk for suicidal
thinking or behavior with use in children and
adolescents. !is “boxed” warning also cautioned
prescribers, other healthcare providers, and
families to be vigilant for behavioral changes (e.g.,
hostility, agitation) in those taking antidepressants,
as these behaviors could be precursors to suicidality.
!is class labeling change was based on a
meta-analysis conducted by the U.S. Food and Drug
Administration (FDA) that revealed a greater
incidence of possible suicidality (behavior or
ideation) in clinical trials of pediatric patients
treated with antidepressants, compared to
Introduction!e suicide rate in the United States fell approximately14 percent from 1985 to 1999.1 !e declinewas largely attributed to the increased use ofselective serotonin reuptake inhibitor (SSRI)antidepressants during this same period.1 In 2004,however, labeling for SSRIs, as well as all prescriptionantidepressants in the United States, began toinclude warnings of an increased risk for suicidalthinking or behavior with use in children andadolescents. !is “boxed” warning also cautionedprescribers, other healthcare providers, andfamilies to be vigilant for behavioral changes (e.g.,hostility, agitation) in those taking antidepressants,as these behaviors could be precursors to suicidality.!is class labeling change was based on ameta-analysis conducted by the U.S. Food and DrugAdministration (FDA) that revealed a greaterincidence of possible suicidality (behavior orideation) in clinical trials of pediatric patientstreated with antidepressants, compared to
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