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Meta-analyses of randomized controlled trials of NGAs in depressed children and adolescents have noted a comparative lack of efficacy, and a weak but statistically significant increased risk of self-harm and suicidal thoughts. But NGA prescription rates and youth suicide rates are generally inversely related, and ensuing \u2018black box\u2019 warnings about NGAs, by deterring NGA prescribing, have possibly contributed to rising youth suicide rates. In moderate\u2013severe depression, benefits for fluoxetine and possibly other NGAs demonstrably outweigh risks. NGAs are not present in adolescents who die by suicide. Concern about NGA risks must be balanced against risks of non-treatment. While mild depression entails regular review, psychoeducation, self-care strategies and psychological interventions, NGAs should be administered concurrently with psychological treatments if depression is moderate\u2013 to severe, or if mild depression persists. Patients should be warned about off-label status of NGAs in depression, serious side-effects such as \u2018activation\u2019, suicidality, emotional blunting and manic switches, the need for adherence and avoiding abrupt discontinuation. They should be monitored early and regularly. Better evidence is required regarding psychological treatments, clinical course, and clinical practice trends. In moderate\u2013severe depression the risk of suicide if NGAs are not used may outweigh any risk of self-harm associated with them.<\/jats:p>","DOI":"10.1080\/00048670802050538","type":"journal-article","created":{"date-parts":[[2009,12,7]],"date-time":"2009-12-07T18:36:09Z","timestamp":1260210969000},"page":"456-466","source":"Crossref","is-referenced-by-count":10,"title":["New-Generation Antidepressants, Suicide and Depressed Adolescents: How Should Clinicians Respond to Changing Evidence?"],"prefix":"10.1177","volume":"42","author":[{"given":"Michael","family":"Dudley","sequence":"first","affiliation":[{"name":"Adolescent Service, Prince of Wales Hospital, Randwick"},{"name":"School of Psychiatry, University of New South Wales, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dusan","family":"Hadzi-Pavlovic","sequence":"additional","affiliation":[{"name":"Black Dog Institute, and School of Psychiatry, University of New South Wales, 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