In the 9 September 2007 issue of Morbidity and Mortality Weekly Report, Lubell et al from the Centers for Disease Control and Prevention (CDC) reported an 8% increase in suicide among US youth and young adults from 2003 to 2004—from 6.78. (n = 4232) to 7.32 (n = 4599) per 100 000.1 The first such change in a decade, it reflected increases in females aged 10–14 and 15–19 years, and males aged 15–19 years. The authors noted an increase in suicides by hanging/suffocation and listed several likely risk factors, including family discord, legal/disciplinary problems, school concerns, and mental health conditions such as depression.12

Controversy regarding potential contributing factors followed soon after. Demonstrating an ecological association between the increased rate and a declining rate of prescriptions for selective serotonin reuptake inhibitor (SSRI) antidepressants, Gibbons et al3 suggested that the latter was a chilling effect of the 2004 black box warning of the US Food and Drug Administration (FDA) against antidepressant use by adolescents. The FDA’s decision to issue a black box warning against SSRI antidepressants was based on secondary …