Two accompanying observational studies by Biddle and colleagues and Wheeler and colleagues add to the recent literature regarding changes in antidepressant use and changes in suicide rates.1 2 The current controversy began in2003,whenreanalyses of data from clinical trials raised concerns that antidepressants might precipitate suicidal thoughts or attempts at suicide. Children and adolescents starting treatment with several newer antidepressants had a 4% risk of developing suicidal ideation or behaviour, compared with 2% in those receiving placebo.3 However, clinical trials cannot determine whether antidepressants increase or decrease the risk of genuine suicide attempts or death from suicide because these outcomes are, fortunately, too rare. No deaths from suicide and few attempts at suicide have occurred to date in trials of antidepressants in adolescents,3 so any clinical trial that could reliably assess effects on death from suicide would require several times more participants than have been included in all such trials to date.

Any …