Pharmacotherapy. Strong linkages between depression and suicidal behaviors have led to substantial investments to prevent suicide by treating those deemed at-risk with antidepressant medications. Published data at the population level have reported decreases in suicide rates related to their administration, but the aggregate nature of the observational data precludes firm conclusions. 94, 95 96 97 Clinicians, patients, and families often attest to the powerful impact of effective treatments. However, the role of antidepressants in reducing youth suicide became controversial after the FDA ‘black box’ warning following concerns about higher rates of suicide-related adverse event reports in pediatric clinical trials of SSRIs, even as there were no deaths. Taken together, the findings of these reviews suggest that fluoxetine has a favorable risk/benefit ratio; other antidepressants may confer a short-term, modest risk of increased non- fatal suicidal behavior for those ages 24 years and younger. Overall, based on observations of the relationship between SSRIs prescription rates and suicide, they will likely benefit most young people to whom they are prescribed under expert guidance. 98 Anecdotally it is clear that many of the cases reported in FDA hearings related to a general lack of supervision by PCPs after prescribing what they thought were relatively benign compounds (being unaware of reported adverse events). Suicide while taking antidepressants is extremely uncommon in young people. Indeed, the clear majority of suicides (including youth) occur in those who are not on medication, as reported in post-mortem toxicology studies, and the results of psychological autopsy studies have repeatedly emphasized a lack of appropriate psychiatric treatment, not an over-prescription of medications.