In this issue of Pediatrics, Leslie and colleagues review the evidence, deliberations, and recommendations of the US Food and Drug Administration scientific advisory committees that led to the black-box warning on the use of antidepressants for children and adolescents. Their article raises a number of critical questions about how we got to this point, including questions about federal drug-regulatory processes and the motivation (or lack thereof) of pharmaceutical companies to design, implement, and report scientifically rigorous trials. However, no question is more compelling than the one faced by many primary care clinicians: How should young patients who are currently on, or potentially in need of, antidepressants be treated?

Although the increased risk of suicidal behavior and ideation for children and adolescents who use antidepressants is statistically significant, unlike Leslie and colleagues, we would not characterize this association as causal for suicidality. In our opinion, the evidence on which...

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