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vidence of a possible association between the use of selective serotonin reuptake inhibitors (SSRIs) and suicide in youth presents a vexing problem for clini- cians, youth and their families. Are these medications the most effective treatment for major depression in children, adolescents and young adults? Do SSRIs carry a greater risk for suicide than no treatment or alternative treatments such as other antidepressants or specific psychotherapies? In this issue, Barbui and colleagues 1 report the results of a meta-analysis of 8 large-scale observational studies that com- pared the risk of suicide among patients with depression who received SSRIs and those with no exposure to antidepres- sants. In contrast to the results reported from a meta-analysis performed by the US Food and Drug Administration (FDA), which concluded that there was a neutral effect of SSRIs on the risk of suicide among adults aged 25-64 years, Barbui and colleagues report a protective effect of SSRIs in this age group. Furthermore, although the FDA concluded that there was increased risk of suicidality associated with the use of antidepressants among youth aged 18-24 years and extended the "black-box" warning for use of antidepressants to this age group, Barbui and colleagues found a beneficial effect. Of in- terest, a study by Gibbons and colleagues, 2 which was in- cluded in the analysis by Barbui and colleagues, included a large sample of patients with major depression from Veter- ans' Affairs centres. This study specifically examined the ef- fect of SSRIs in patients aged 18-25 years. Gibbons and col- leagues found a protective effect of antidepressants in terms of lower rates of suicide attempts compared to patients who received no treatment. They also reported a protective effect of SSRIs when the risk of suicide was compared in the same cohort before and during treatment. Barbui and colleagues found a higher rate of suicide at- tempts and completions among adolescents and a lower rate among adults whose depression was treated with SSRIs. These results are reassuring for adults and their clinicians and fami- lies, but worrisome for adolescents and their clinicians and families. However, we must reconcile these findings with other conflicting data. Sondergard and colleagues 3 noted that

Proper studies of selective serotonin reuptake inhibitors are needed for youth with depression