Objective. This study evaluates changes in use of antidepressants in children 
and adolescents after the US Food and Drug Administration black box warning for 
increased risk of suicide.Method. A retrospective chart review was completed for 
children and adolescents (ages 4-17) who were diagnosed with depressive or 
anxiety disorders in an outpatient clinic and offered a trial of antidepressants 
between September 2003 and February 2004 (before the black box warning) and 
between January 2005 and June 2005 (after the black box warning). Statistical 
analyses were performed with the SPSS version 17 and R package version 2.9.1. 
Univariate analysis was conducted using the Fisher's Exact test.Results. The 
odds ratio calculated for the different groups suggests that in all the groups, 
the proportion of acceptance of antidepressant use was greater before the black 
box warning as compared to after the black box warning (odds ratio>1). It was 
also found that upon combining the age groups after the warning and comparing 
them, based on the diagnoses, there was a greater degree of refusal of 
antidepressant therapy when a diagnosis of anxiety disorder was made as compared 
to a diagnosis of depressive disorder (p=0.017).Conclusion. There has been a 
decrease in the use of antidepressant therapy in children and adolescents 
following the US Food and Drug Administration black box warning for risk of 
suicide. A limitation of this study is that reasons for refusal of 
antidepressent therapy by parents or guardians of children and adolescents were 
not collected; therefore, there is no certainty that the black box warning was 
the primary reason for refusal.