OBJECTIVE: In 2002, 264 children and adolescents ages 5-14 died by suicide in 
the United States, the fifth leading cause of death. Of these suicides, 260 were 
in the 10-14 year age group, making suicide the third largest cause of death 
behind accidents and malignancy. Although 60% of suicides in the general 
population occur in the midst of a mood disorder, usually untreated, little is 
known about the relationship between treatment of mood disorders and youth 
suicide. The FDA recently linked adverse event reports of suicidal ideation 
among children and adolescents in randomized controlled trials to selective 
serotonin reuptake inhibitors (SSRIs) and consequently required a change in 
labeling that included a black box warning regarding SSRI use for all age 
groups. Given that the age-adjusted suicide rate is about six times higher in 
15-19 year olds compared with 10-14 year olds, the risk-benefit ratio may be 
different in younger children. Therefore, this study examined the association 
between antidepressant medication prescription rate and suicide rate in children 
ages 5-14 prior to the FDA findings by analyzing associations at the county 
level across the United States.
METHOD: National county-level suicide rate data among children ages 5-14 were 
broken down by sex, income, and race during the period 1996-1998. National 
county-level antidepressant prescription rate data were expressed as number of 
pills prescribed per person. The primary outcome measure was the suicide rate in 
each county expressed as number of suicides for a given population size.
RESULTS: After adjustment for sex, race, income, access to mental health care, 
and county-to-county variability in suicide rates, higher SSRI prescription 
rates were associated with lower suicide rates in children and adolescents.
CONCLUSIONS: The aggregate nature of these observational data precludes a direct 
causal interpretation of the results. More SSRI prescriptions are associated 
with lower suicide rates in children and may reflect antidepressant efficacy, 
treatment compliance, better quality mental health care, and low toxicity in the 
event of a suicide attempt by overdose.