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those receiving antidepressants. The average risk of such events in patients treated withan antidepressant was 4% compared with 2% of patients given placebo. There wasconsiderable variation in risk among the antidepressants, but there was a tendencytowards and increase for almost all antidepressants studied. The risk of suicidality wasmost consistently observed in the major depressive disorder trials, but there were signalsof risk arising from trials in other psychiatric indications (obsessive compulsive disorderand social anxiety disorder) as well. No suicides occurred in these trials. It is unknownwhether the suicidality risk in children and adolescent patients extends to use beyondseveral months. The nine antidepressant medications in the pooled analyses included fiveSSRIs (citalopram, fluoxetine, fluvoxamine, paroxetine, sertraline) and four non-SSRIs(bupropion, mirtazapine, nefazodone, venlafaxine).Symptoms of anxiety, agitation, panic attacks, insomnia, irritability, hostility(aggressiveness), impulsivity, akathisia (psychomotor restlessness), hypomania andmania have been reported in adults, adolescents and children being treated withantidepressants for major depressive disorder as well as for other indications, bothpsychiatric and nonpsychiatric. Although a causal link between the emergence of suchsymptoms and either worsening of depression and/or emergence of suicidal impulses hasnot been established, there is concern that such symptoms may be precursors of emergingsuicidality.Families and caregivers of children and adolescents being treated with antidepressants formajor depressive disorder or for any other condition (psychiatric or nonpsychiatric)should be informed about the need to monitor these patients for the emergence ofagitation, irritability, unusual changes in behaviour and other symptoms described above,as well as the emergence of suicidality, and to report such symptoms immediately tohealthcare providers. It is particularly important that monitoring be undertaken duringthe initial few months of antidepressant treatment or at times of dose increase ordecrease.Duloxetine hydrochloride is not indicated for use in patients under the age of 18.Although a causal role for duloxetine in inducing such events has not been established,some analyses from pooled studies of antidepressants in psychiatric disorders found anincreased risk for suicidal ideation and/or suicidal behaviors in pediatric and young adult(