In 2004, the US Food and Drug Administration (FDA) controversially issued a 
black box warning that antidepressants were associated with an increased risk of 
suicidal thoughts and behaviours in people aged under 18 years. In 2007, the 
warning was expanded to include young adults aged under 25 years. In 2005, the 
Australian Therapeutic Goods Administration responded to the FDA warning by 
requiring Product and Consumer Information leaflets to be updated to reflect the 
risk. However, there was considerable debate, and at times emotive backlash, in 
academic journals and the international media. Prominent US and Australian 
mental health organisations and psychiatrists challenged the FDA warning. They 
argued that, on balance, antidepressant use was likely to reduce the risk of 
suicide. Several ecological studies were cited misleadingly as evidence that 
decreasing antidepressant use increases suicide risk. From 2008 to 2018, 
Australian per-capita child, adolescent and young adult antidepressant 
dispensing (0-27 years of age) and suicide (0-24 years) rates have increased 
approximately 66% and 49%, respectively. In addition, there was a 98% increase 
in intentional poisonings among 5 to 19 year-olds in New South Wales and 
Victoria between 2006 and 2016, with substantial overlap between the most 
commonly dispensed psychotropics and the drugs most commonly used in 
self-poisoning. These results do not support claims that increased 
antidepressant use reduces youth suicide risk. They are more consistent with the 
FDA warning and the hypothesis that antidepressant use increases the risk of 
suicide and self-harm by young people. Causal relationships cannot be 
established with certainty until there is a vast improvement in post-marketing 
surveillance. However, there is clear evidence that more young Australians are 
taking antidepressants, and more young Australians are killing themselves and 
self-harming, often by intentionally overdosing on the very substances that are 
supposed to help them.